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The thorax has protective (mobile) walls around the vital cardiorespiratory viscera.

This protection prevents palpation except for transmitted input and (implied*) movement.

The thorax is a module*.

The regions* that make up the module are walls* and contents*. Impalpable contents emphasize the importance of surface knowledge.

Where all the major viscera share a sensory supply (T4/5), knowledge of neurosomes is the only way to truly make sense of referred pain*.

The concealed nature of thoracic viscera makes investigation more likely.

Spontaneous pneumothorax is common in young males. It is probably related to a congenital or acquired defect. Both lungs are affected with equal frequency. In patients over 40, it is usually caused by chronic airways disease.

The leak may be localized if adhesions* are present - more likely, it is generalized. The negative intrapleural pressure becomes positive and the elastic recoil of the lung causes it to collapse towards the hilum. An open passage between lung and pleural cavity creates a bronchopulmonary fistula*. If the passage closes off, air will be reabsorbed*.

If the soft tissue around the passage acts like a valve (air sucked into the space but not expelled), a tension* pneumothorax is present.

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