Abnormal thorax
Introduction
Introduction The thorax consists of the thoracic spine, sternum, ribs and intercostal tissue. There are chest wall and shoulder muscles, and there is a pleura inside. The upper thoracic cavity is a ring composed of the upper edge of the sternum and the first rib. It is called the thoracic entrance. The tracheal esophagus and the large blood vessels pass through this mouth and pass from the neck to the chest. The lower mouth of the thorax is closed by the diaphragm. Only a few holes communicate with the chest and abdomen, and some organs pass through the hole. The normal thorax profile is roughly symmetrical on both sides. The anteroposterior diameter of the adult thorax is shorter than the left and right diameters. The ratio of the two is 1:1.5. The anteroposterior diameter of the children and the elderly is slightly smaller than the transverse diameter. If the size of the thorax is found during the examination, the shape changes significantly, and the normal state is lost. The thoracic symmetry or asymmetrical morphological change is the thoracic abnormality. Because of the different degree of deformation of the various structures of the thoracic tissue, various forms of thoracic abnormalities are exhibited.
Cause
Cause
Causes of thoracic abnormalities
Abnormal thoracic morphology can be caused by intrathoracic or systemic diseases, but also due to congenital causes.
1. Thoracic disorders are often caused by ribs, costal cartilage, spine and chest wall, chronic inflammation or tumor. Such as rib fractures, costal cartilage inflammation, thoracic tuberculosis, benign and malignant tumors of the chest wall and thoracic trauma.
2, pleural effusion pleural effusion, pneumothorax can make the thoracic (affected side) full; extensive pleural adhesion, hypertrophy when the thoracic collapse; pleural mesothelioma makes the thorax is full.
3, respiratory diseases, extensive lung fibrosis, atelectasis, emphysema, etc. can cause the thoracic whole or local malformation, collapse or bulging. Lung cancer may be accompanied by alveolar dysplasia, emphysema or metastasis to the pleura and ribs.
4, circulatory system disease heart enlargement, pericardial effusion, aortic aneurysm, constrictive pericarditis, etc. can cause local thoracic abnormalities.
5, nutritional deficiency children lack of vitamin D can cause rickets, congenital rickets; calcium, phosphorus deficiency, bone can not be calcified, chest or other skeletal malformations, chronic wasting diseases.
Examine
an examination
Related inspection
Pleural effusion check serous effusion pathogen pulse shock lung function (IOS) cardiopulmonary exercise test (CPET) chest B-ultrasound
First, clinical manifestations
Smaller thorax can be considered congenital thoracic deformity, long-term bedridden patients, rickets and hypertrophic adenoid hyperplasia; chest enlargement is mostly barrel chest, seen in chronic bronchitis, bronchial asthma, emphysema and the elderly and Obese body shape; changes in the shape of the thorax can be various, such as flat chest, barrel chest, chicken breast, funnel chest, unilateral or localized deformation of the thorax.
Second, laboratory inspection
Serum phosphorus, calcium, alkaline phosphatase and urinary calcium, phosphorus content changes, help to diagnose rickets; respiratory disorders caused by thoracic abnormalities, sputum and exfoliated cell examination, pleural fluid test and biopsy There are corresponding changes.
Third, the device inspection
1. X-ray examination: The types of thoracic deformities are different and each has its own characteristics. The barrel-shaped chest shows that the ribs are horizontal, the intercostal space is widened, and the diaphragm is low. The flat chest is slender and flat. The posterior anterior X-ray examination of the funnel chest showed that the ribs were tilted downwards, the heart was shifted to the left, and the lateral sternum was recessed in Albania to make the spine sounds short. The chicken breast is opposite to the shape of the funnel chest, with flattened thorax on both sides, anterior sternum and anterior ribs.
2, pulmonary function test: obstructive emphysema caused by barrel-shaped chest mainly obstructive ventilatory dysfunction, such as FEV, maximum ventilation decreased, residual gas volume increased, residual gas volume as a percentage of total lung volume increased, spinal deformity, funnel Chest, flat chest, etc. can be characterized by limited ventilatory dysfunction, lung capacity, total lung volume, residual gas volume can be slightly reduced, FEV is normal.
Diagnosis
Differential diagnosis
Symptoms that are easily confused with thoracic abnormalities:
One side of the thoracic collapse: may be caused by empyema or pleurisy, extensive pleural thickening adhesion and contraction, atelectasis, pulmonary fibrosis, chronic fibrotic tuberculosis, chronic lung suppuration and other diseases. The clinical manifestations vary with the primary disease. The trachea moves to the affected side, the thoracic contour of the affected side becomes smaller, and the common scoliosis of the spine is common.
Thoracic stenosis and flattening: common in juvenile vertebral osteochondrosis, hunchback as the main symptom, with spinal rigidity. The neck often flexes, the shoulders sag, and the shoulder blades protrude.
Thoracic deformation: snoring during sleep makes the airway narrow, respiratory resistance increases, so it will forcefully inhale and pull the thorax. At this time, the child is in the stage of growth and development, and the bones are relatively soft, which may easily lead to deformation of the thorax in the long run.
Thoracic deformity: The chicken breast is named after the chest wall is wedge-shaped and convex like the sternum of a bird. The funnel chest is a concave deformity of the chest wall, shaped like a funnel. These are two common thoracic deformities.
The thorax also has a collapsed deformity: the sign of the funnel chest, the sternum (especially the root of the xiphoid) and its corresponding 3rd to 6th costal cartilage are trapped inward, causing the front chest wall to resemble a funnel and the heart is displaced. A physical examination can be diagnosed.
