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A pneumothorax is an accumulation of air or other gases in the space surrounding the lungs. It can occur spontaneously, as a complication of diseases of the lung, after a chest trauma, and even as a complication of medical treatment. It generally presents with chest pain and shortness of breath. It can often be diagnosed with a physical examination, but in many cases requires an x-ray or CT Scan of the chest. A pneumothorax can lead to oxygen shortage, low blood pressure and cardiac arrest. However, a small pneumothorax will often resolve itself without treatment.
The air generally comes from a leak in the lungs filling the pleural cavity (closed), but can also occur when the pleural cavity is punctured from the outside (open). This prevents the space (which is generally kept as a partial vacuum) from allowing the lungs to expand into it when the patient breathes. The progression of symptoms is generally a factor of the size of the leak. In an emergency, a physician will create a hole in the pleural cavity, which converts a closed pneumothorax into an open pneumothorax - still a condition needing treatment. A syringe may be used to draw air out of the lungs, but in severe cases, an open one-way valve chest tube will be inserted into the pleural cavity.
Smoking increases the risk of a spontaneous pneumothorax, although they can also occur when the patient undergoes a sudden change of air pressure, or at concerts where loud music is played. In many cases, the discomfort is mild and a patient may wait several days before seeking out treatment.
A tension pneumothorax is a pneumothorax where severe hypoxia persists even when the patient is given oxygen, or is accompanied by falling blood pressure or confusion. It is caused when the pressure inside the pleural cavity grows larger as the patient continues to breathe. This type of pneumothorax is a medical emergency.
During an examination, the physician may note muffled breathing sounds, high pitched sounds when the chest is percussed, and changes to the patient's voice.
On House, there have been several cases of pneumothorax:
- Dr. Cate Milton suffered a pneumothorax due to a fat embolism damaging her lungs and had to insert a syringe into her own chest to treat it in Frozen.
- Dana Miller diagnosed herself with a pneumothorax and asked bystanders to call 911 in The Greater Good.
- Hanna suffered a trauma induced pneumothorax in Help Me.