Restrictive Chest Wall Disorders

Abstract

Hypoventilation can be caused by diseases of the chest wall. Any anatomical or functional abnormality of the bony thorax increases dead space ventilation and the work of breathing, whether congenital or acquired, acute or chronic, and whether its cause is infectious, traumatic, environmental, iatrogenic, or unknown. In this article, we discuss these heterogeneous disorders from the viewpoint of the practicing nonpediatric pulmonary physician, only briefly touching on surgical, pediatric, rheumatologic, and other nonpulmonary ramifications. Emphasis is on the most common and the best researched forms of chest wall restriction, including kyphoscoliosis, fibrothorax, thoracoplasty, flail chest, and ankylosing spondylitis. Other diseases such as osteoporosis with its less well known pulmonary effects, and some rarely seen entities, are briefly discussed.

Restrictive pulmonary function is more prevalent in patients with ankylosing spondylitis than in matched population controls and is associated with impaired spinal mobility: a comparative study

“…AS is characterized by inflammation in the thoracic vertebrae and in the costovertebral joints, causing gradual fusion and ossification of the joints, for some patients ultimately resulting in increased dorsal kyphosis, rigidity of the thorax and permanent chest wall immobility [5,6]. Reduced lung volumes have been suggested to be a consequence of mechanical limitations, due to bony ankylosis of the thoracic joints [7], because restrictive respiratory impairment frequently has been reported to be associated with low thoracic expansibility [6-10].…”

“…Reduced lung volumes have been suggested to be a consequence of mechanical limitations, due to bony ankylosis of the thoracic joints [7], because restrictive respiratory impairment frequently has been reported to be associated with low thoracic expansibility [6-10]. Additionally, some claim that ongoing inflammatory processes in the thoracic joints may explain limitations of chest excursions, by causing pain and stiffness, and thus contributing to reduced pulmonary function [5,9,11]. Others suggest that pleuropulmonary tissue is an independent primary target in AS [12,13], and that inflammatory processes in the lung parenchyma with a tendency to fibrosis might be as significant as mechanical factors in the development of reduced pulmonary function in AS [9,14,15].…”

“…Others suggest that pleuropulmonary tissue is an independent primary target in AS [12,13], and that inflammatory processes in the lung parenchyma with a tendency to fibrosis might be as significant as mechanical factors in the development of reduced pulmonary function in AS [9,14,15]. However, reports have differed regarding whether pulmonary function worsens with disease progression [5], and whether respiratory restriction correlates with limitation of chest wall movements [5,6,13,16,17]. …”

Cardiorespiratory Effects of Derotational Casting during Anesthesia for Children with Early Onset Scoliosis

“…Scoliotic changes in chest wall architecture over stretch chest wall muscles on the convex side of the thoracic spine curve and cause muscle contracture on the concave side of the curve. The thoracic cage asymmetry causes aberrations in muscle lengthtension relationships resulting in increased work of breathing [1,2]. Abnormal thoracic cage growth restricts pulmonary alveolar development thereby causing pulmonary hypoplasia and/or atelectasis.…”

Estimating Breathing Movements of the Chest and Abdominal Wall Using a Simple, Newly Developed Breathing Movement-Measuring Device

“…A loss in mobility may be due to various factors such as aging, 1,2 scoliosis, 3,4 thoracoabdominal surgery, 5,6 ankylosing spondylitis, 7 and other chest wall diseases. 8 Therefore, chest and abdominal mobility assessments should be performed in a variety of clinical settings.…”