Holes are sometimes useful. Put a few holes in a bowl, and you can sift through water to find gold or drain water from pasta.

Now imagine pumping air into a sack with one little hole in it, and no matter how hard you blow, the air will not stay in the sack. 

Now, what if the sack were your lung? Such is the case with a pneumothorax.

A pneumothorax is a rare condition caused by a hole in a lung that causes it to collapse. This became a reality for three high school students.

According to senior Emily Hayes, a certified EMT, a lung naturally has a layer of air between the visceral pleura (the wall of the lung) and the parietal pleura (the lining between the rib cage and the lungs). The layer of air keeps the lung inflated by creating a vacuum with negative pressure, Hayes said.

However, weak spots may be present in the visceral pleura, she continued, and movement of the lung can rip open a hole, causing air to fill the space between the visceral and the parietal pleura. As more air builds up outside of the lung, the air loses its negative pressure and the vacuum disappears.

Without the vacuum, the lung starts to collapse.

According to sophomore Max Wu, one of the students with the condition, a pneumothorax can occur from physical damage — such as a hard hit to the chest — rupturing the lung. In rare cases, however, this condition occurs spontaneously, causing a hole to appear randomly in the lung without outside influence.

Atsuo Chiu, ’18, junior Spencer Scott and Wu received consecutive diagnoses of spontaneous pneumothorax — the rarest form of the condition — within two years. 

What wasn’t uncommon, though, was that all three were males. 

That gender disparity isn’t a coincidence, according to the U.S. National Library of Medicine. The condition occurs in approximately .000127 percent of U.S. males and .000036 percent of U.S. females. 

And according to Wu’s father, Mike Wu, his son, diagnosed with a spontaneous pneumothorax in 2018, fit the description of people in which the condition occurs. 

“The doctors said that spontaneous pneumothorax happens to skinny male teens,” Mike Wu said. 

Another “skinny male teen”— Chiu — said he had the “classic sudden chest pain and shortness of breath” characterized by the condition after school one day. Max Wu, though, wasn’t in as calm of a situation; he was on the move.  

“I was on my way to basketball practice, and when I got out of the car, I felt a pain in my chest,” Max Wu said. “It wasn’t anything too bad, and I thought, ‘It will just go away.’”

But according to Max Wu, this pain rapidly intensified during his practice.

“When I started playing, I got bumped around a bit,” Max Wu said. “That was when I felt a really sharp pain in my chest, and I had to sit out for the rest of the practice.”

After he went home, Max Wu was unable to do his homework due to the pain. His father took him to the hospital the next day for an X-ray, which revealed a pneumothorax. 

“(The doctors) said that one side of his lungs collapsed and an air pocket has formed in the space,” Mike Wu said.

That didn’t mean the Wus were free to go home, and that explanation “freaked out” the sophomore.

“I had a mini heart attack,” Max Wu said. “They told me I had a hole in my lung, and I was immediately going to go to the emergency room,” Max Wu said.

His father was also overwhelmed by the news.  

“I was very concerned,” Mike Wu said. “I didn’t know about pneumothorax or the risks or what we’re dealing with. It seemed very serious — the doctors told us to go straight to the E.R.”

According to Mike Wu, the doctors installed a Thora-Vent into his lung to pump air out of the air pocket. In addition to sealing the hole and recirculating the air, the device monitors the intrapleural pressure via a diaphragm that moves up and down with respiration. 

Once the pneumothorax is resolved, the diaphragm stays permanently in the “down” position, according to Kardia Medical Inc. 

Almost two years before Max Wu’s pneumothorax, the same condition struck Scott in the middle of a history class in December 2016. 

“I grabbed my binder, stood up and felt a really sharp pain in my lung,” Scott said. 

“I walked across campus with this really sharp pain — like a knife in my chest — to physics where I took a test. I went through the test, (but) later I had to text my mom (to pick me up) because it really hurt.” 

Scott said he had an X-ray and returned to school. The next day his parents received Scott’s diagnosis. 

“I was at a friend’s house,” Scott said. “My parents picked me up because they got a call from the doctor, who said I needed to get to the hospital because I had a hole in my lung. 

“Then my parents were like, ‘Oh, sweet Jesus.’”  

According to Scott, he was given an oxygen treatment upon arriving at the hospital. 

“They thought the (trapped) air might just (flow) out of my (chest),” Scott said. 

“It sounded like a smart idea since a doctor was doing it, but it didn’t work. I just sat there for about an hour inhaling oxygen.”

After the oxygen treatment failed, Scott was sent to the intensive care unit for surgery.

“They (said they) would cut a hole in my side, stick a tube in and suck the air out,” Scott said. 

“They told me that I would end up with a tube in my side, and it would be really uncomfortable.”

According to Scott, the surgery took about an hour, and the Thora-Vent chest tube stayed in his body for the rest of the day.

“What was really interesting was that the skin above my lung felt like an inflated balloon when I pressed my chest,” he said.

But unlike Scott’s, Max Wu’s tube stayed in for a few days. 

“After removing the tube, the doctor gave me two options,” Max Wu said. “Either I could do surgery to permanently remove the chance of this happening again on my right lung, or I could take the risk.” 

Max Wu said the surgery was very expensive and would take two days to complete, so he declined.

“I didn’t want to do it — it was really scary,” Max Wu said.  

However, without getting the second surgery, he risks recurrence, he said.

“I have a bigger chance of getting it again, and my lung will deflate faster,” he said. “If I don’t go to the emergency room immediately, I might die.”

According to the U.S. National Library of Medicine, 13 to 60 percent of patients had a recurrence. 

Despite the risk, Max Wu continues to play on Country Day’s boys basketball team.

By Ming Zhu

Originally published in the Jan. 15 issue of the Octagon

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