chestwall - Chest wall disorders & the lung: A group of...

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Chest wall disorders & the lung: A group of conditions affecting the Inspiratory pump and potentially leading to respiratory failure. Disorders may affect all mechanical components of the Inspiratory pump. • Respiratory muscles • Bony rib cage • The spine and its articulations. • Soft tissue compromising the abdomen Lead to a mechanical disadvantage to the Inspiratory pump and an increased work of breathing. Characterized usually by a restrictive defect. Share the potential of long term hypercapnic respiratory failure
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1.Spine & articulations: Kyphoscoliosis Thoracoplasty 2.Rib cage: flail chest( esp with pulmonary contusion.) Pectus excavatum/ Pectus carinatum Ankylosing spondylitis. 3. Respiratory muscle involvement: Central Peripheral: nerve/ neuromuscular junction/ muscle. 4.Soft tissue: obesity. Etiology of chest wall disorders:
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Kyphosis may exist as an isolated entity. Osteoporosis. post-radiation. Estimated prevalence: mild deformity 1 in 1000 severe deformity 1 in 10000 in U.S Scoliosis invariably associated with Kyphosis. A. Congenital Isolated Associated syndromes: NF/ Marfan’s /EDS. B. Paralytic/ Secondary Neuromuscular: poliomyelitis/ M. dystrophy /CP/CMT syndromes. connective tissue related: EDS/ Morquio’s. vertebral disease: osteoporosis/ osteomalacia/ spina bifida. compensatory: post Thoracoplasty. C. Idiopathic .
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Often begins in early adolescence a female predominance (4 to 1) May account for as many as 80% of cases of Kyphoscoliosis The Cobb angle is associated with the degree of restriction. The relationship is however more complex. Other factors involved are: 1. Number Of Vertebrae 2. Location of curve 3. Patient’s age. 4. Presence of Kyphosis 5. Degree of rotation Idiopathic Kyphoscoliosis
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Congenital Kyphoscoliosis : Isolated or Syndromic/may be genetic present at birth Malformations of vertebrate( during ontogeny) loss of VC 15% greater than in idiopathic scoliosis . Paralytic Kyphoscoliosis : loss of muscular tone primary secondary unequal resting tone & remodeling. should be ruled before other 2 categories considered. association between scoliosis & restriction not strong. reduction of VC primarily assoc with weakness. early onset of scoliosis . faster progression.
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Pathophysiology of Kyphoscoliosis Maximum restriction among chest wall disorders. Pulmonary function testing : TLC VC N/ RV NF EV 1 / FVC FEV1 RV/TLC. FEV1 reduced proportional to the restriction. Specific airway conductance is actually increased( radial traction because of recoil.) Mimics obstructive disease.
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Think of 1.torsion of central airways 2.impingement of mediastinal structure( eg aorta) on the airways. 3.smoking related obstructive airways disease. DL CO both steady-state and single-breath measurements are often reduced in proportion to the reduction in TLC.
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This note was uploaded on 12/03/2011 for the course MEDICINE 350 taught by Professor Dr.aslam during the Winter '07 term at Medical College.

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chestwall - Chest wall disorders & the lung: A group of...

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