상기 환자 대학병원에 3일간 입원 후 퇴원
"산소치료만 받았다.", "퇴원시 조금 남아 있었는데 추적 위해 내원하였다."
추적 흉부 엑스레이에서 남아 있는 기흉은 관찰되지 않았다.
"처음에는 흉관 삽관을 하려고 하였다."
; 폐의 첨부만 흉막과 폐의 간격이 벌어져 있어 산소치료 정도를 기대했었지만.. 초기에는 그랬다고 한다.
INDICATIONS FOR TUBE THORACOSTOMY
Thoracostomy has evolved as a primary treatment for evacuation of air or fluid in the pleural space from a myriad of causes. Air within the pleural space is one of the most common reasons for a chest tube. Within the context of pneumothoraces, indications include:
Large (> 25% or apex to copula distance > 3 cm) primary spontaneous pneumothorax; small pneumothorax in this patient population with no underlying lung disease can usually be managed with observation alone
Mechanically ventilated patients with pneumothorax or effusions to decrease the work of breathing and help the patient wean off the ventilator
Secondary spontaneous pneumothorax. Patients with underlying lung disease (cystic fibrosis, interstitial lung disease, emphysema, etc.) will benefit from thoracostomy. They usually have pronounced symptoms and a high recurrence rate with no intervention. There have been reports of increased mortality in those patients where clinical observation is done for small pneumothoraces. Large (> 25% or apex to cupula distance > 3 cm) pneumothorax requires chest tube placement.
Hemodynamically unstable patient
Recurrent or persistent pneumothorax
Tension pneumothorax requires needle decompression followed by an ipsilateral chest tube
Pneumothorax related to trauma
흉관 삽관이 필요한 긴장성 기흉
호흡기내과 전공의 시절 폐조직검사 후 자주 시행했던 흉관 삽관에 대한 기억
동대문구 답십리 우리안애, 우리안愛 내과, 건강검진 클리닉 내과 전문의 전병연
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