Pulmonary emphysema | Barrel thorax

Pulmonary emphysema

In pulmonary emphysema, the lungs are over-inflated because the inhaled air is trapped at the end of the airways in the form of emphysema bubbles and cannot be exhaled again. In most cases, the cause is chronic obstructive pulmonary disease (COPD), which affects smokers in 90% of cases. Chronic inflammation leads to narrowing of the airways.

Some of the air inhaled cannot leave the narrowed airways and emphysema bubbles form. However, these cannot participate in the gas exchange, but cause the lungs to over-inflate. Over the course of months and years, this over-inflation leads to a change in the morphology of the bony thorax as it widens in the sagittal plane (from the lateral view).

Symptoms

Since a barrel thorax develops over months and years, the patient himself usually does not notice any of these changes. For the experienced physician, however, a barrel thorax is a visual diagnosis. Since a pharyngeal thorax is not a disease in itself, but a symptom or a consequence of other diseases, the symptoms of these causative diseases are in the foreground. If a fascia thorax is caused by emphysema, patients also complain of shortness of breath, reduced breathing width and cyanosis (blue coloration of the lips or mucous membranes due to reduced gas exchange).If a grasping thorax is due to a wear-related change in the thoracic spine, those affected also often suffer from chronic back pain and restricted mobility.

Diagnosis

Often a grasping thorax is already recognizable as a gaze diagnosis without further diagnostics. The characteristic shape can be easily recognized by the shortened and widened shape of the ribcage, depending on the characteristics of the thorax. On the one hand, the bony thorax can be further assessed in an x-ray; here a widened lower thoracic aperture (thoracic entrance) and horizontally standing ribs are noticeable.

Degenerative changes in the spinal column, which lead to an altered thoracic shape, can also be diagnosed in an X-ray. In addition, conventional X-rays can provide a rough assessment of the lungs, and special X-ray signs may be noticed that indicate pulmonary emphysema. When making a diagnosis, however, it is important to make it clear that a grasping thorax is not a disease but merely a symptom, and thus the diagnosis of the underlying disease (most frequently emphysema or degenerative changes in the thoracic spine) must be the main focus.

A pronounced grasping thorax can already be determined by a simple gaze diagnosis. However, an X-ray of the thorax provides further important information. In an x-ray of a grasping thorax, the ribs are largely horizontal.

In a healthy patient, on the other hand, the ribs should run from back-up to front-down. In addition, the distance between the ribs is increased in the presence of a grasping thorax. The diaphragm is deep and flattened.

The over-inflation of the lung can be shown by an increased radiation transparency. The affected lung tissue thus appears darker on X-ray than healthy parts of the lung. In addition, blood vessels are no longer clearly visible in the presence of a fascia thorax.