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When the thorax has been opened for the drainage of an acute empyema, almost invariably there is a gush of pus under tension. During inspiration, there is a sound of suction as the air rushes into the chest; during expiration, straining or coughing, the pus and air are forcibly expelled through the thoracotomy wound. This is partly explained by the fact that during inspiration the entire thorax increases in capacity, while during expiration its volume decreases. There is, however, another cause for the violent ejection of fluid and air, and this can be easily demonstrated by the fluoroscope, or, more strikingly, when a wide thoracotomy with free exposure of the lung has been made. It will be seen in both instances that the lung of the open side increases in volume with forced expiration, while it decreases on inspiration. If the mediastinum is mobile, it will be deviated toward the
LILIENTHAL H, AMBERSON JB. UNILATERAL PNEUMOTHORAXTHE BEHAVIOR OF THE MEDIASTINUM. Arch Surg. 1929;18(1_PART_II):533-541. doi:10.1001/archsurg.1929.04420020355024