Chest wall deformities

Impaired lung motion due to pleural effusion or pneumothorax Adult respiratory distress syndrome Chest wall diseases and chest wall deformities Neurological disorders affecting the muscles of respiration... 

Chetcuti P, Myers NA, Phelan PD et al (1989) Chest wall deformity in patients with repaired esophageal atresia. I Pediatr Surg 24 244-247... 

Despite these results, UCAs are primarily used in either transthoracic or transesophageal echocardiography. Contrast-aided echocardiography has been used in the diagnosis of cardiomyopathy, chest wall deformities, heart valve defects, and numerous other cardiac applications. " ... 

Fig. 19.20 Lateral chest x-ray from a patient with a dual-unipolar DDD pacing system. The course of the ventricular lead is bizarre and attributed to a very pronounced pectus excavatum chest wall deformity. Capture thresholds were excellent, the paced QRS had a LBBB pattern, and a transesophageal echo confirmed that the lead was in the right ventricle.

Amyotrophic lateral sclerosis Myasthenia gravis Muscular dystrophies, polymyositis Chest wall deformities Kyphoscoliosis Ankylosing spondylitis Chest trauma Thoracoplasty Pleural thickening... 

Restoration of central chemosensitivity— by the effective control of nocturnal hypoventilation— has been shown in patients with severe obstructive sleep apnea (13), neuromuscular disease (14), and chest wall deformity as well as patients with COPD (15,16). 

During the 1970s, more patients with respiratory failure due to neuromuscular disorders and chest wall deformities received long-term ventilatory assistance at home, either via tracheostomy or body ventilators, which provided effective nocturnal noninvasive ventilation (NIV) (5,6). In the 1970s, the development of home respiratory therapy companies improved support for home mechanical ventilation (HMV). Respiratory therapists could now set up ventilatory equipment, educate the patient and caregivers about using the equipment, and be available to deal with problems. 

Figure 3 Percentage of users in each disease category by country. The symbol represents lung/ airways (COPD, cystic fibrosis, bronchiectasis, pulmonary fibrosis, and pediatric diseases) , chest wall deformities (kyphoscoliosis, old TB, OHS, surgical resection) and , neuromuscular disorders (muscular dystrophy, motor neuron disease, post-polio kyphoscoliosis, central hypoventilation, spinal cord damage, and phrenic nerve palsy). Abbreviations COPD, chronic obstructive pulmonary disease TB, tuberculosis OHS, obesity hypoventilation syndrome. Source From Ref. 15.

Mechanical restriction caused by chest bellows malfunction may result from chest wall or skeletal deformity, loss of neuromuscular function, fibrosis of the pleural space, and abdominal overdistension causing upward displacement of the diaphragm, as well as decreased diaphragm movement. The most common pulmonary function pattern seen in these patients is a decrease in TLC and VC with only a slight decrease in RV. The RV is maintained in these diseases because lung compliance remains normal. The Dlco is normal or only minimally reduced, and the Dlco a (corrected for alveolar volume) is normal. The RV/TLC ratio is often increased in patients with restrictive chest bellows disease. Patients with neuromuscular disease also have reduced respiratory muscle function with a reduction in their MIP. 

A large number of conditions can result in chronic ventilatory failure and patients with these conditions may benefit from home ventilation. Typically, patients with restrictive disorders have decreased compliance of the chest wall, resulting from a thoracic cage deformity or from respiratory muscle involvement (1). In patients with severe obstructive pulmonary disorders, respiratory muscle fatigue and alveolar hypoventilation, especially during sleep, are thought to contribute to respiratory failure (2,3) (Table 1). 

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