每日一题_2023.09.18

A 28-year-old smoker presents to the emergency department because of sudden onset of chest pain and dyspnea while at rest. His heart rate is 115/min, respiratory rate is 24/min, and blood pressure is 140/80 mm Hg in both arms. Lung examination shows decreased breath sounds and decreased fremitus on the right with hyperresonance to percussion. Which of the following would most likely be seen on this patient’s x-ray of the chest?

一名28岁吸烟者因休息时突发胸痛和呼吸困难到急诊科就诊。他的心率为115/min，呼吸频率为24/min，两臂血压为140/80 mmhg。肺部检查示右侧呼吸音减低，震颤减弱，叩击高共振。以下哪一项最可能在该患者的胸部x线片中出现?

(A)  A widened mediastinum纵隔增宽

(B)  Barrel chest and flattened diaphragm桶状胸和扁平的膈肌

(C)  Consolidation in the right lower lobe右肺下叶实变

(D)  Contralateral deviation of the trachea气管对侧偏移

(E)  Tracheal deviation to the ipsilateral side; elevated diaphragm on the right side气管向同侧偏移;右侧膈肌升高

答案解析：

这个病人很可能患有自发性气胸。自发性气胸是由肺表面的顶部小泡破裂引起的，通常发生于高大的年轻男性。患者通常突发疼痛和呼吸困难。检查显示患侧呼吸音减低和高共振。胸部x线片显示胸廓过度扩张，患侧膈肌升高。这种反常的腹部运动是由于胸腔内的负压导致疲劳的膈肌被拉入右侧胸腔而发生的。自发性气胸的治疗方法是插入胸管，将空气从胸膜腔中抽出。

正确答案：E