Deformities

of
rib cage
Dr. Abdul Ghani Waseem
Deformities of rib cage

 The two most common types of chest wall deformity are:

 Pectus excavatum.
 Pectus carinatum.

 Deformities such as pectus carinatum and pectus excavatum affect roughly 1

in 1,500 children.
 These deformities cause the chest to bow outwards or inwards.
PECTUS CARINATUM

 Pectus carinatum, also known as pigeon chest or raised chest.

 Pectus carinatum is characterized by a protrusion of the sternum that occurs

as a result of an abnormal and unequal growth of the costal cartilages
connecting the ribs to the sternum.

 Rather than growing symmetrically along the chest wall, the costal cartilages

over grow outward, pushing the sternum forward. 
PECTUS CARINATUM
PECTUS CARINATUM
PECTUS EXCAVATUM

 Pectus excavatum, also known as funnel chest or concave chest.

 Pectus excavatum is characterized by a depression in the sternum, typically the lower half of the
sternum.

  The depression of the sternum causes cardiac compression and lung capacity restriction. 

 When severe, patients may experience:

 Shortness of breath
 Chest pain
 Asthma-like symptoms.
 The malformation may also cause poor body self-image for patients.
PECTUS EXCAVATUM
PECTUS EXCAVATUM
MANAGEMENT OF PECTUS DEFORMITES
Jeune Syndrome

 Jeune Syndrome is a form of congenital dwarfism that leads to a chest wall

deformity; the chest is extremely small.

 The ribs are often abnormal, broad, short and irregularly joined to the costal
cartilages and sternum.
 This produces a small bell-shaped, inflexible chest cavity, which doesn't grow
well and makes breathing difficult.
 Symptoms may begin in the newborn period, up to 4–5 years of age and can
range from mild to severe.
 The most severe form may make breathing very difficult and the child may
require help from a mechanical ventilator.
Jeune Syndrome
Poland Syndrome

 Poland Syndrome consists of a spectrum of abnormalities of one side of the

chest including the absence of the pectoralis muscle(s), under development
of breast tissue and areola, rib abnormalities and, in some cases, inadequate
development of the arm, hand, and fingers of the same side.

 The right side of the body is affected twice as often as the left.

 Poland syndrome affects males more commonly than females. 

Poland Syndrome
Poland Syndrome
Primary rib anomalies

 Primary rib anomalies can be the cause of chest wall deformities.

 There are 12 pairs of ribs that connect to the vertebra.
 Ribs 1 through 10 connect in the back and to the sternum on the front of the
chest, by segments of cartilage.
 Rib abnormalities are variable and include extra or absent ribs, and partially
developed or fused ribs. 
Primary rib anomalies
Primary rib anomalies
Primary rib anomalies
Dry pleurisy
Dry pleurisy

 Pleurisy may be characterized as dry or wet.

 In dry pleurisy, little or no abnormal fluid accumulates in the pleural cavity,

and the inflamed surfaces of the pleura produce an abnormal sound called a
pleural friction rub when they rub against one another during respiration.
Symptoms of Dry pleurisy

 The most common symptom of pleurisy is a sharp chest pain when breathing

deeply.

 Sometimes the pain is also felt in the shoulder.

 The pain may be worse when you cough, sneeze or move around, and it may
be relieved by taking shallow breaths.

 Other symptoms can include shortness of breath and a dry cough.

 Causes of Dry pleurisy

 Common causes of dry pleurisy include:

 Pneumonia.
 Pulmonary embolus
 Lung cancer
 Trauma to the chest wall.
 Treatment Of Dry pleurisy

 The pain and inflammation associated with pleurisy is usually treated with

nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.

 Occasionally, steroids.

 TREAT THE UNDERLYING CONDITION

 The outcome of pleurisy treatment depends on the seriousness of the
underlying disease
CHEST TRAUMA
Chest trauma

 A chest injury, also known as chest trauma, is any form of physical injury to

the chest including the ribs, heart and lungs.

  Chest injuries account for 25% of all deaths from traumatic injury.

Chest trauma
CAUSES

Chest injuries may be caused by:

Blunt injury, such as from sport, or from a punch or kick, or from a fall.

Penetrating wound, such as from a gun or a knife.

Crushing injury, such as from a road accident.

 The most common signs and symptoms are: pain in the chest that gets worse
when laughing, coughing or sneezing. tenderness. bruising.
...
Symptoms of a fractured rib are:
 extreme pain when breathing in.
 tenderness to the chest or back over the ribs.
 a 'crunchy' feeling under the skin.
 severe shortness of breath.
 One segment of the chest wall may not move with breathing or move
opposite to the rest of the chest wall (flail chest).
Flail chest
Chest trauma

 Primary treatment of chest-wall injuries involves a combination of :

 Close observation for respiratory decompensation.

 Pain control.

 Aggressive pulmonary and physical therapy

 Selective use of intubation and ventilation

BRONCHITIS
Bronchitis

 Bronchitis is an inflammation of the lining of the bronchial tubes, which

carry air to and from the lungs
Division of the trachea

 The trachea begins just under the larynx (voice box) and runs down behind

the breastbone (sternum).
 The trachea then divides into two smaller tubes called bronchi: one
bronchus for each lung.
 They undergo further branching to produce the secondary bronchi.
 Each secondary bronchi supplies a lobe of the lung, and gives rise to several
segmental bronchi.
 The segmental bronchi undergo further branching to form numerous smaller
airways – the bronchioles.
Division of the trachea
Clinical features

 The most common symptom is a cough.

 Other symptoms include
 Production of mucus
 Wheezing
 Shortness of breath
 Fever
 Chest discomfort.
Complications

Although a single episode of bronchitis usually isn't cause for concern, it can lead
to pneumonia in some people.

Repeated bouts of bronchitis, however, may mean that the patient have chronic
obstructive pulmonary disease (COPD).
INVESTIGATIONS

 BLOOD CP.
 To look for signs of infection.

 X RAY CHEST
 To see that the lungs and bronchial tubes look normal and rule out
pneumonia.
EMPYEMA
Empyema

Empyema is a collection of pus in the pleural space.

Empyema
Causes

Most common cause of empyema is pneumonia.

An empyema can form when pneumonia fails to fully respond to treatment

Bronchiectasis 

Tuberculosis

Pulmonary infarction

Serious injury to the chest and Surgery to the chest

Secondary to food aspiration

Symptoms

Empyema can be simple or complex.

Simple empyema
Simple empyema occurs in the early stages of the illness.
A person has this type if the pus is free-flowing.

The symptoms of simple empyema include:

Shortness of breath
Dry cough
Fever
Chest pain when breathing that may be described as stabbing.
Sweating
Headache
Confusion
Loss of appetite
Symptoms

Complex empyema
Complex empyema occurs in the later stage of the illness.

In complex empyema, the inflammation is more severe.

Scar tissue may form and divide the chest cavity into smaller cavities. This is called loculation, and it’s more difficult to treat.

If the infection continues to get worse, it can lead to the formation of a thick peel over the pleura, called a pleural peel. This peel
prevents the lung from expanding. Surgery is required to fix it.

Other symptoms in complex empyema include:

Difficultybreathing
Decreased breath sounds
Weight loss
Chest pain
Complications

In rare instances, a case of complex empyema can lead to more severe complications.
These include sepsis and  pneumothorax.

The symptoms of sepsis include:

High fever
Chills
Rapid breathing
Tachy cardia
Hypotension

A pneumothorax can cause sudden, sharp chest pain and shortness of breath that gets worse
when coughing or breathing.

These conditions can be fatal.

.
INVESTIGATIOS
BLOOD CP:

Blood tests can help check the white blood cell count.

White cell count can be elevated in bacterial infection.

ESR

C-reactive protein.

BLOOD C/S

Identify the bacteria causing the infection.

.
INVESTIGATIOS

Chest x-rays.

 CT scans Chest

 willshow whether or not there’s fluid in the

pleural space.
CHEST X-RAYS
CT SCANS CHEST
INVESTIGATIOS

Ultrasound of the chest

 Thoracentesis
INVESTIGATIOS

Ultrasound of the chest

An ultrasound of the chest will show the amount of fluid and its exact location.
INVESTIGATIOS

During a thoracentesis, a needle is inserted through the back of the ribcage into the
pleural space to take a sample of fluid.

The fluid is then analyzed under a microscope to look for bacteria, protein, and other
cells.
Thoracentesis
Treatment

Treatment is aimed at removing the pus and fluid from the pleura and treating the infection.

Antibiotics are used to treat the underlying infection.

The specific type of antibiotic depends on what type of bacteria is causing the infection.

Needle aspiration:

The method used to drain the pus depends on the stage of the empyema.

In simple cases, a needle can be inserted into the pleural space to drain the fluid. This is called percutaneous 
thoracentesis.

Chest intubation:
In the later stages, or complex empyema, a drainage tube must be used to drain the pus. This procedure is usually
performed under anesthesia in an operating room.
Thoracentesis
Treatment

There are different types of surgery for this:

Thoracostomy

Video-assisted thoracic surgery 

Open decortication 
Treatment

There are different types of surgery for this:

Thoracostomy

Surgical tube thoracostomy is insertion of a surgical tube into the pleural space

to drain air or fluid from the chest .

Then they’ll connect the tube to a suction device and remove the fluid.
Thoracostomy
Thoracentesis
Treatment

Video-assisted thoracic surgery: 

Surgeon will remove the affected tissue around the lung and then insert a drainage tube or
use medication to remove the fluid.

They will create three small incisions and use a tiny camera called a thoracoscope for this
process.

.
Treatment

Open decortication: 

Decortication is a surgical procedure that removes a restrictive layer of fibrous

tissue overlying the lung, chest wall, and diaphragm.

The aim of decortication is to remove this layer and allow the lung to reexpand.
Open decortication: 
Acute Respiratory Distress Syndrome
Acute Respiratory Distress Syndrome
Acute Respiratory Distress Syndrome

 Acute respiratory distress syndrome (ARDS) is a severe lung condition. It occurs

when fluid fills up the air sacs in the lungs. Too much fluid in the lungs can
lower the amount of oxygen or increase the amount of carbon dioxide in your
bloodstream.

 ARDS can prevent the organs from getting the oxygen they need to function,
and it can eventually cause organ failure.
 ARDS most commonly affects hospitalized people who are very ill. It can also
be caused by serious trauma. Symptoms usually occur within a day or two of
the original illness or trauma, and they may include extreme shortness of
breath and gasping for air.
 ARDS is a medical emergency and a potentially life-threatening condition.
 Causes of acute respiratory distress syndrome

 Inhaling toxic substances, such as salt water, chemicals, smoke, and vomit
 Sec. to sepsis.
 Sec. to pneumonia.
 Injury to the chest or head, such as during a car wreck or contact sports
 Overdosing on sedatives or tricyclic antidepressants
Symptoms of acute respiratory distress syndrome

 Signs and symptoms that you are developing or are at risk for ARDS may
include:
 Shortness of breath.
 Tachycardia
 Fever.
 Productive Cough.
 cyanosis.
 Fatigue.
 Risk factors for acute respiratory distress syndrome

 ARDS is usually a complication of another condition.

 These factors increase the risk of developing ARDS:
 age over 65 years
 chronic lung disease
 a history of alcohol misuse or cigarette smoking.

 ARDS can be a more serious condition for people who:

 have toxic shock
 are older
 have liver failure
 have a history of alcohol misuse
INVESTIGATIONS

Blood test
Chest x-ray
CT scan
Throat and nose swabs
Electrocardiogram
Echocardiogram

Low blood pressure and low blood oxygen can be signs of ARDS. The doctor may
rely on an electrocardiogram and echocardiogram to rule out a heart condition.
 If a chest X-ray or CT scan then reveals fluid-filled air sacs in the lungs, a
diagnosis for ARDS is confirmed.
Chest x-ray
Chest x-ray
Chest x-ray
Treatment

 Oxygen
 The primary goal of ARDS treatment is to ensure a person has enough oxygen
to prevent organ failure.
 Administer oxygen by mask.
 A mechanical ventilation machine can also be used to force air into the lungs
and reduce fluid in the air sacs.
 Management of fluids
 Management of fluid intake is another ARDS treatment strategy. This can help
ensure an adequate fluid balance.
 Too much fluid in the body can lead to fluid buildup in the lungs. However,
too little fluid can cause the organs and heart to become strained.
Treatment

 Medication
 People with ARDS are often given medication to deal with side effects. These include
the following types of medications:
 Pain medication to relieve discomfort
 Antibiotics to treat an infection
 Blood thinners to keep clots from forming in the lungs or legs.

 Pulmonary rehabilitation
 People recovering from ARDS may need pulmonary rehabilitation. This is a way to
strengthen the respiratory system and increase lung capacity. Such programs can
include exercise training, lifestyle classes, and support teams to aid in recovery from
ARDS.
THANK YOU