intercostal space narrowing
Introduction
Introduction 12 pairs of ribs participate in the thorax, and the gap between the ribs and the ribs is the intercostal space. There are intercostal muscles, blood vessels, nerves and connective tissue membranes. The width of the rib gap is different, the gap of the upper rib is wider, and the lower part is narrower; the front part of the rib gap is wider, and the back part is narrower, but can change with the change of body position.
Cause
Cause
Dysplasia, caused by malnutrition. 12 pairs of ribs participate in the thorax, and the gap between the ribs and the ribs is the intercostal space. There are intercostal muscles, blood vessels, nerves and connective tissue membranes. The width of the rib gap is different, the gap of the upper rib is wider, and the lower part is narrower; the front part of the rib gap is wider, and the back part is narrower, but can change with the change of body position. The width of the rib gap is different, the gap of the upper rib is wider, and the lower part is narrower; the front part of the rib gap is wider, and the back part is narrower, but can change with the change of body position. The ribs are curved and elastic, and the 5th to 8th ribs are large and prone to fracture. If the fracture end is displaced inward, it can pierce the pleural and intercostal vascular nerves, and even puncture the lungs to cause hemothorax, pneumothorax or atelectasis.
Examine
an examination
Related inspection
ECG rib lock extrusion test
Common is the left lower chest depression. The width of the rib gap is different, the gap of the upper rib is wider, and the lower part is narrower; the front part of the rib gap is wider, and the back part is narrower, but can change with the change of body position. The ribs are curved and elastic, and the 5th to 8th ribs are large and prone to fracture. If the fracture end is displaced inward, it can pierce the pleural and intercostal vascular nerves, and even puncture the lungs to cause hemothorax, pneumothorax or atelectasis.
The rib space can be narrowed by examining the body and chest X-ray films.
Diagnosis
Differential diagnosis
1, barrel chest
It is more common in emphysema caused by airway asthma, chronic bronchitis, etc., which can be seen in elderly and short-skinned people. The anteroposterior diameter and the left and right diameter of the thorax are increased, especially the anteroposterior diameter is significantly increased, sometimes equal to the left and right diameters, so that the chest is barrel-shaped, the anterior lower slope of the rib arch is lifted, the intercostal space is widened, and the respiratory movement is significant. Decreased, palpation fainting weakened or disappeared, percussion leaves were unvoiced, heart sounds narrowed or not easy to shed, lower lung and liver dullness decreased, auscultation was far away, breath sounds weakened, exhalation prolonged, concurrent infection, lungs There may be a pronounced sound, the X-ray shows the thoracic expansion, the intercostal space is widened, the ribs are not working, the activity is weakened, and the diaphragm is lowered and flattened. When emphysema is complicated, the lung capacity is reduced in one second, and the residual volume is increased in obstructive ventilatory dysfunction.
2, flat chest
Found in chronic wasting diseases such as tuberculosis, it can also be seen in patients with elongated body shape, flat thorax, small anteroposterior diameter and often short half of the diameter. The clavicle protrudes, the upper and lower fossa are obvious, the ribs are drooping, the intercostal space is small, the intercostal muscles are atrophy, and the upper abdomen angle is acute. The flat chest is often accompanied by weakness signs, the visceral sagging, the thoracic expansion is poor, and it is prone to tuberculosis. It used to be called tuberculosis.
3, funnel chest
The disease is congenital dysplasia and has a genetic predisposition such as marfans syndrome. The funnel chest is a funnel-shaped thoracic deformity in the lower part of the sternum and the xiphoid. The lower thorax of the patient is flat, and the sternal angle collapses to the rear. The xiphoid is most obvious. The distance between the lower end of the sternum and the spine is shortened. The ribs on both sides of the sternum are curved, and may be associated with posterior vertebral protrusion or other deformities. The thoracic motion is often limited, and the heart is displaced by the pressure, and most of them are called to the left. Clinical manifestations, the thoracic deformity in infants and young children can be inconspicuous, more asymptomatic, with the increase of age, the chestnut deformity gradually worsens, dyspnea, palpitations, anterior heart pain and chronic bronchitis, symptoms of pneumonia, lungs can be smelled and wet? Sound, due to heart shift, can be heard and heart sound splitting and systolic murmur. X-ray examination showed a shift in the heart and the degree of depression after the lower end of the sternum. Electrocardiogram has changes in heart shift and transition, and pulmonary function tests are restrictive ventilatory dysfunction. If combined with chronic bronchitis, recurrent episodes can cause obstructive ventilatory dysfunction.
4, chicken breast
Because of rickets, repeated respiratory infections in childhood can also cause chicken breasts. The chest of the chicken chest is protruding forward, especially the lower part. The anteroposterior diameter of the thorax is enlarged, the transverse diameter is reduced, and more often accompanied by one or both rib cartilage depressions. The joint between the rib and the costal cartilage is thickened and thickened, and is beaded; the anterior rib of the chest is everted, and the diaphragm of the respiratory muscle contracts, causing the inner side of the chest wall to be pulled inward, and the sternal xiphoid is formed inward from the attachment point of the iliac muscle. Deep ditch. It is called the rib groove. The disease is more common in children and adolescents, also known as rickets. X-ray examination showed flattened thoracic sides, anterior sternum and rib cartilage anterior. Pulmonary function tests are restrictive ventilatory dysfunction.
5, spinal deformity
There are many causes, due to congenital dysplasia accompanied by vertebral deformity, or secondary to tuberculosis, rickets, osteomalacia, trauma, neuromuscular lesions and severe pleural thickening, thoracoplasty, etc., but most of the causes are unknown. The disease is caused by the thoracic vertebrae bending backward and backward to cause thoracic deformity. In severe cases, the rib space on the convex side of the spine is obviously widened, and the thoracic bulge is raised. The rib space of the concave side of the thorax is narrowed, and the thoracic cavity is depressed, causing compression of the lungs and dysplasia of the lungs or causing localized atelectasis. Unstressed lungs can produce compensatory emphysema. Patients are prone to chronic bronchitis and develop to right heart hypertrophy and pulmonary heart disease. The main clinical manifestations are progressive dyspnea, shallow breathing, increased heart rate, and cyanosis. Lower respiratory tract infections and pneumonia are the main causes of respiratory failure and heart failure. There are usually no obvious symptoms in childhood. X-ray examination can be used for angular spinal deformity and chest, diaphragm muscle activity and lung conditions. Pulmonary function was restricted ventilatory dysfunction, accompanied by chronic bronchitis, varying degrees of obstructive ventilatory dysfunction.
