Barrel-shaped Chest Research Articles

COMPUTED TOMOGRAPHY FEATURES OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE
 ASSOCIATED WITH LUNG CANCER

Relevance: Chronic obstructive pulmonary disease (COPD) associated with lung cancer is common in smoking patients. Computed tomography (CT) is vital in detecting lung cancer, assessing regional lung parenchymal destruction, and airway remodeling in COPD.
 ДИАГНОСТИКА
 40 Онкология и радиология Казахстана, №1 (63) 2022
 The study aimed to determine the CT features of COPD associated with lung cancer.
 Methods: This retrospective study included chest CT exams of 56 patients over the age of 40, with a smoking history of 10 years and more and
 with suspected COPD. 46.43% of patients had CT signs of lung cancer associated with COPD.
 Results: Barrel-shaped chest (19.23%), saber-sheath trachea (7.69%), and bronchiectasis (15.38%) were less common in patients with lung
 cancer. Paraseptal and centrilobular emphysema were diagnosed in 96.15%, bullae – 73.33%. Bronchial narrowing of the lumen and wall thickening were identified for all lobar bronchus, segmental bronchus, and subsegmental bronchus.
 Conclusion: Paraseptal and centrilobular emphysema and bullae in the upper lobes of lungs were predominant CT features in patients with
 COPD associated with lung cancer. Lumen narrowing and wall thickening of lobar bronchus, segmental bronchus, and subsegmental bronchus
 were also revealed.

COMPUTED TOMOGRAPHY FEATURES OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE ASSOCIATED WITH LUNG CANCER

Relevance: Chronic obstructive pulmonary disease (COPD) associated with lung can-cer is common in smoking patients. Computed
 tomography (CT) is vital in detecting lung cancer, assessing regional lung parenchymal destruction, and airway remodeling in COPD.
 The study aimed to determine the CT features of COPD associated with lung cancer.
 Methods: This retrospective study included chest CT exams of 56 patients over the age of 40 with a smoking history of 10 years and
 more and with suspected COPD. 46.43% of patients had CT signs of lung cancer associated with COPD.
 Results: Barrel-shaped chest (19.23%), saber-sheath trachea(7.69%), and bronchiecta-sis (15.38%) were less common in patients with
 lung cancer. 96.15% were diagnosed with paraseptal and centrilobular emphysema, bullae – 73.33%. Bronchial narrowing of the lumen
 and wall thickening were identified for all lobar bronchus, segmen-tal bronchus, and subsegmental bronchus.
 Conclusion: Paraseptal and centrilobular emphysema and bullae in the upper lobes of the lungs were predominant CT features in
 patients with COPD associated with lung cancer. Lumen narrowing and wall thickening of lobar bronchus, segmental bronchus, and subsegmental bronchus were also revealed.

Association between severity of disease and thoracic wall dimensions among chronic obstructive pulmonary disease patients – A cross sectional study

Introduction and Aim: Pulmonary function worsens with the intensification of disease severity. Chronic obstructive pulmonary disease (COPD) may cause changes in the shape of the thoracic cage due to increasing lung volumes and dynamic hyperinflation. To assess the association between the severity of COPD and thoracic wall dimensions among COPD patients.
 Materials and Methods: A cross-sectional study was conducted in a tertiary care teaching hospital on 80 COPD subjects aged above 18 years. Based on the severity of obstruction of COPD, subjects were divided into two groups-moderate obstruction and severe obstruction. Severity of obstruction constituted the primary outcome variable. The primary explanatory variables were the dimensions of the thoracic wall. Their association was assessed by calculating the Spearman correlation and Pearson correlation coefficient and represented in a scatter diagram.
 Results: Majority (60%) had an MMRC dyspnea grading of 3. Moderate Obstruction was seen in 62.5% of subjects while 37.50% had severe obstruction. There was no statistically significant difference between the groups with respect to antero posterior (AP) diameter, transverse diameter, AP to transverse diameter ratio and Height of Diaphragm (HDI). There was a moderate negative correlation FVC (L) and HDI, FEV1/FVC (%) and HDI which was statistically significant. There was also a weak negative statistically significant correlation between FVC (L) and AP diameter, FVC (L) and transverse Diameter, FVC (L) and AP to transverse diameter ratio, FEV1/FVC (%) and AP diameter, FEV1/FVC (%) and transverse diameter.
 Conclusion: There was a significant moderate negative correlation between the height of the diaphragm and severity of COPD (FVC, FEV1/FVC %). In COPD, the mechanical deformation leads to difficulty in breathing because of reduction in the lung capacity of patients. Early and aggressive treatment in patients with COPD can be beneficial.
 Keywords: Chronic obstructive pulmonary disease; global initiative for chronic obstructive lung disease; medical research council dyspnoea scale; barrel-shaped chest; spirometry, diaphragm.

Late diagnosis of total anomalous pulmonary venous drainage in a 5.5-month-old infant.

A 5.5-month-old girl was admitted with non-specific signs and symptoms like dyspnea at rest, tachypnea, fatigue, low body weight and cyanosis on exertion. Physical examination revealed a barrel-shaped chest; no pathological sounds over the heart or both lung areas were detected. The above mentioned symptoms might suggest a circulatory problem. Echocardiography and computed tomography angiography were performed. These examinations revealed supracardiac type total anomalous pulmonary venous drainage. Echocardiographic signs of pulmonary hypertension and severe right ventricle overload were detected. Detailed analysis of both imaging examinations revealed atypical obstruction of the pulmonary venous return: narrowing of the proximal part of superior vena cava. An urgent surgery was performed, with no complications in the postoperative period. A follow-up echocardiography showed normalization of cardiac function and pulmonary pressure as well as normalization of flow profile within the superior vena cava. The paper presents a non-invasive diagnostic process in the described case, and discusses the causes of late diagnosis.

Physical signs in patients with chronic obstructive pulmonary disease.

We reviewed the various physical signs of chronic obstructive pulmonary disease, their pathogenesis, and clinical importance. We searched PubMed, EMBASE, and the CINAHL from inception to March 2018. We used the following search terms: chronic obstructive pulmonary disease, physical examination, purse-lip breathing, breath sound intensity, forced expiratory time, abdominal paradox, Hoover's sign, barrel-shaped chest, accessory muscle use, etc. All types of studies were chosen. Globally, history taking and clinical examination of the patients is on the wane. One reason can be a significant development in the field of medical technology, resulting in overreliance on sophisticated diagnostic machines, investigative procedures, and medical tests as first-line modalities of patient's management. In resource-constrained countries, detailed history taking and physical examination should be emphasized as one of the important modalities in patient's diagnosis and management. Declining bedside skills and clinical aptitude among the physician is indeed a concern nowadays. Physical diagnosis of chronic obstructive pulmonary disease (COPD) is the quickest and reliable modalities that can lead to early diagnosis and management of COPD patients. Bedside elicitation of physical signs should always be the starting point for any diagnosis and therapeutic approach.

AB168. Novel DYM compound heterozygous mutations in a Malaysian boy with Dyggve-Melchior-Clausen syndrome

Background Dyggve-Melchior-Clausen (DMC) syndrome and Smith-McCort Dysplasia (SMC) are rare, progressive, autosomal recessive skeletal dysplasias caused by mutations in the Dymeclin (DYM) gene, mapped to chromosome 18q21.1. These are allelic disorders and share many features including short stature, a barrel-shaped chest, platyspondyly, abnormalities of the epiphyses and metaphyses, and a distinctive lacy appearance of the iliac crest. The distinguishing feature is that individuals with DMC have intellectual disabilities whereas SMC is associated with normal intelligence.

Mechanism of sternotomy dehiscence.

Biomechanical modelling of the forces acting on a median sternotomy can explain the mechanism of sternotomy dehiscence, leading to improved closure techniques. Chest wall forces on 40 kPa coughing were measured using a novel finite element analysis (FEA) ellipsoid chest model, based on average measurements of eight adult male thoracic computerized tomography (CT) scans, with Pearson's correlation coefficient used to assess the anatomical accuracy. Another FEA model was constructed representing the barrel chest of chronic obstructive pulmonary disease (COPD) patients. Six, seven and eight trans-sternal and figure-of-eight closures were tested against both FEA models. Comparison between chest wall measurements from CT data and the normal ellipsoid FEA model showed an accurate fit (P < 0.001, correlation coefficients: coronal r = 0.998, sagittal r = 0.991). Coughing caused rotational moments of 92 Nm, pivoting at the suprasternal notch for the normal FEA model, rising to 118 Nm in the COPD model (t-test, P < 0.001). The threshold for dehiscence was 84 Nm with a six-sternal-wire closure, 107 Nm with seven wires, 127 Nm with eight wires and 71 Nm for three figure-of-eights. The normal rib cage closely fits the ellipsoid FEA model. Lateral chest wall forces were significantly higher in the barrel-shaped chest. Rotational moments generated by forces acting on a six-sternal-wire closure at the suprasternal notch were sufficient to cause lateral distraction pivoting at the top of the manubrium. The six-sternal-wire closure may be successfully enhanced by the addition of one or two extra wires at the lower end of the sternotomy, depending on chest wall shape.

Gorlin Goltz syndrome: A clinicopathological case report

The Gorlin-Goltz syndrome is an infrequent multisystemic disease, which is inherited in an autosomal dominant manner. This shows a high level of penetrance and variable expressiveness, characterized by multiple basal cell nevi or carcinomas, odontogenic keratocysts, palmar and / or plantar pits, calcification of the falx cerebri, and is occasionally associated with internal malignancies. It is fundamental to know the major and minor criteria for the diagnosis and early preventive treatment of this syndrome. Here we report a case of a 30-year-old male with major and minor features of the Gorlin-Goltz syndrome, such as, strabismus, barrel-shaped chest, with drooping shoulders and mild kyphosis, polydactyly, hypertelorism, multiple basal cell carcinomas, calcification of the falx cerebri, C5-C7 bifida spine, and fusion of T1 and T2.

Evaluation of Some Anatomical and Anthropometric Characteristics of the Chest Based on the Analysis of Digital Images of the Anterior Aspect of Trunk in Top Athletes

Evaluation of Some Anatomical and Anthropometric Characteristics of the Chest Based on the Analysis of Digital Images of the Anterior Aspect of Trunk in Top Athletes The aim of this research was to assess the size and shape of the chest in students and top athletes. The research involved 23 first-year students of the Faculty of Sport and Physical Education, and 23 top athletes of the Athletic Federation of Serbia. The digital images of the frontal trunk aspect were made and further analyzed in ImageJ program. The vertical and horizontal distances and as well as the angles were determined: the infrasternal angle and the angle of umbilicus (sides of the angle connect the points on the left and right). Both students and athletes were divided into three height groups (I - 165-174 cm; II - 175-184 cm; III - 185-194 cm). BMI and BI were determined (shoulder width). No statistical differences in height, weight and BMI among the groups of students and top athletes were found, which pointed to the homogeneity of the groups. All the parameters determined, the vertical and horizontal ones, except AAD, were significantly higher in top athletes (p ≤ 0.05) compared to the same parameters obtained in students of all three height groups. Acromial distance increases with height, but not statistically significantly. The above mentioned indicates a significantly better development of the bone-joint-muscle system of the chest in top athletes. The infrasternalni angle correlates with the angle of the umbilicus and it can be used to assess the shape of the chest. In our researches, analysing the individual cases, the presence of normasthenic, asthenic (elongated) and barrel-shaped chest was determined. The program ImageJ is very precise, objective and easily applicable for determining the lenghtwise parameters and angles in anatomic and anthropometric measurements. The method does not require anthropometric equipment, digital images can be made quickly and efficiently. Therefore, we consider it particularly suitable for measurements in childhood and athletes.

The Prototype Development of Clothing for Pet Dogs

The purpose of this study is to develop the most appropriate garment patterns for dog. This study is analyzed the body structures and bodily movements of different types of dogs and constructed garment patterns that are appropriate for each category: the basic pattern for dogs with oval-shaped chests; and the modified pattern for the ones with barrel-shaped chests. Analyzing some of the existing patterns in the market as well as studying the size chart of one of the dog apparel manufacturers, who participated in the Fashion Week for the very first time, were undertaken in order to understand the bodily figures and movements of dogs. Furthermore, based the previous studies and relevant information available regarding some of the most popular dogs in four selected countries: (names of the selected countries), dogs were broadly categorized into three groups according to the shape of their chests: Oval, Barrel, and Flat-sided. Later, two types of pattern were created and then constructed for fitting: the basic pattern for oval-shaped chest; and the modified pattern for barrel-shaped chest. As a result, the two patterns turned out to be most suitable for pet dogs.

A novel RNA-splicing mutation in TRAPPC2 gene causing X-linked spondyloepiphyseal dysplasia tarda in a large Chinese family

X-linked spondyloepiphyseal dysplasia tarda (SEDT; OMIM 313400) is a rare osteochondrodysplasia that occurs in affected individuals between 3 and 12 yr of age. Clinical features include short trunk, barrel-shaped chest and disproportionate short stature. Radiological abnormalities may become evident between 10 and 14 yr of age and include platyspondyly with hump-shaped central and posterior portions of the vertebrae, narrow disc spaces and moderate epiphyseal dysplasia of the long bones, which may be associated with osteoarthritis. Female heterozygous carriers are clinically and radiographically normal. SEDT is caused by mutations in the TRAPPC2 gene, (trafficking protein particle complex 2), which spans a genomic region of ∼20 kb in Xp22. In a large Chinese SEDT family, we screened all the six exons of the TRAPPC2 gene and identified a novel RNA-splicing mutation (IVS4+1A>G). We also demonstrated that the mutation induced splice pattern change from AT/AC to GT/AG. As a result, the first seven nucleotides of exon 5 were spliced out from the transcript. The prediction of the amino acid sequence showed that the seven nucleotides deletion of the transcript caused frame shift and led to premature translation termination, causing loss of two alpha helices. The results of our study expand the spectrum of the gene mutations associated with SEDT, and will help further to elucidate the role of this protein in the etiology of this form of osteochondrodysplasia. X-linked spondyloepiphyseal dysplasia tarda mutations in the TRAPPC2 gene previously identified as SEDL gene,

The Halo Fixator

The halo fixator may be used for the definitive treatment of cervical spine trauma, preoperative reduction in the patient with spinal deformity, and adjunctive postoperative stabilization following cervical spine surgery. Halo fixation decreases cervical motion by 30% to 96%. Absolute contraindications include cranial fracture, infection, and severe soft-tissue injury at the proposed pin sites. Relative contraindications include severe chest trauma, obesity, advanced age, and a barrel-shaped chest. In children, a computed tomography scan of the head should be obtained before pin placement to determine cranial bone thickness. Complications of halo fixation include pin loosening, pin site infection, and skin breakdown. A concerning rate of life-threatening complications, such as respiratory distress, has been reported in elderly patients. Despite a paucity of contemporary data, recent retrospective studies have demonstrated acceptable results for halo fixation in managing some upper and lower cervical spine injuries.

A single nucleotide deletion of 293delT in SEDL gene causing spondyloepiphyseal dysplasia tarda in a four-generation Chinese family

Spondyloepiphyseal Dysplasia Tarda (SEDT; MIM 313400) is a rare genetically heterogeneous disorder of vertebral and epiphyseal growth resulting in disproportionally short-trunked short stature, barrel-shaped chest, and dysplasia of the large joints. It is caused by the mutations of SEDL gene. The distinctive radiological signs and the X-linked mode of inheritance make it easy to diagnose. Here a four-generation Chinese SEDT family has been analyzed and the disease-causing mutation has been found. After polymerase chain reaction (PCR)-single strand conformation polymorphism (SSCP) analysis and DNA sequencing, a previously unreported deletion of T in exon 5 of SEDL gene (i.e. 293delT) was observed and seven individuals in the family carried the mutation. It results in frameshift and a putative truncated protein with the 97 N-terminal amino acids, and 9 changed amino acids. Therefore, loss of function of the gene could be predicted. However, this mutation has not been detected in 50 age and sex matched unrelated controls.

Evidence That Smith-McCort Dysplasia and Dyggve-Melchior-Clausen Dysplasia Are Allelic Disorders That Result from Mutations in a Gene on Chromosome 18q12

Smith-McCort dysplasia is a rare autosomal recessive osteochondrodysplasia characterized by short limbs and a short trunk with a barrel-shaped chest. The radiographic phenotype includes platyspondyly, generalized abnormalities of the epiphyses and metaphyses, and a distinctive lacy appearance of the iliac crest. We performed a genomewide scan in a consanguineous family from Guam and found evidence of linkage to loci on chromosome 18q12. Analysis of a second, smaller family was also consistent with linkage to this region, producing a maximum combined two-point LOD score of 3.04 at a recombination fraction of 0 for the marker at locus D18S450. A 10.7-cM region containing the disease gene was defined by recombination events in two affected individuals in the larger family. Furthermore, all affected children in the larger family were homozygous for a subset of marker loci within this region, defining a 1.5-cM interval likely to contain the defective gene. Analysis of three small, unrelated families with Dyggve-Melchior-Clausen syndrome, a radiographically identical disorder with the additional clinical finding of mental retardation, provided evidence of linkage to the same region, a result consistent with the hypothesis that the two disorders are allelic.

Pulmonary interstitial emphysema, pneumomediastinum, and pneumothorax. Occurrence in the newborn infant.

The clinical course of pulmonary interstitial emphysema (PIE), pneumomediastinum (PM), and pneumothorax (PT) was studied in 57 premature and 20 fullterm newborn infants. The results suggest that PIE, PM, and PT represent a continuum of a single process. Pneumomediastinum and PT without radiological evidence of PIE occurs with greater frequency in full-term infants, while PIE predominantly occurs in the preterm infant. Respiratory distress syndrome significantly increases the incidence of PIE. The presence of PIE was associated with a significant increase in mortality in the group of infants studied. In spontaneous cases a distinct clinical picture often precedes radiologic changes. This consists of barrel-shaped chest, retractions, tachypnea, and increased ambient oxygen requirements.

Pulmonary emphysema and fibrosis.

1)Thirty-seven patients with pulmonary emphysema and/or fibrosis have been reviewed. The outstanding symptoms are dyspnea, cyanosis and cough. The main findings on examination are barrel-shaped chest with limited respiratory excursion, hyper-resonance on percussion, hypertrophy of the auxiliary respiratory muscles and decreased pulmonary function. Roentgenograms are typical showing hyperaeration and/or fibrosis. Review of autopsy findings reveals simultaneous occurrence of emphysema and fibrosis in almost all cases. Emphysema involves either both lungs diffusely in the vesicular form or forms irregular, large air cysts in the bullous form. Frequent complications are recurrent pneumonia, hypertension of the lesser circulation with pulmonary atherosclerosis and cor pulmonale, spontaneous pneumothorax and cerebral changes. 2)No specific cause is known. 3)Treatment is unsatisfactory and is limited to the alleviation of symptoms, oxygen being the most effective agent. Artificial pneumoperitoneum and abdominal supports have been used to relieve dyspnea. Surgical intervention is reserved for cases with one or more giant bullae and consists of resection or drainage of the bullae. FIGURE 4Idiopathic progressive fibrosis, etiology undetermined. This condition was progressive, with increasing evidence of emphysema, cardiac involvement with extreme dyspnea. FIGURE 5Bullous emphysema.

Pulmonary Emphysema Associated with Arrested Pulmonary Tuberculosis

THE purpose of my paper is to demonstrate how the x-rays can help in the diagnosis of emphysema, and to emphasize the importance of this study. I shall limit myself to emphysema in arrested tuberculosis, but I urge radiologists to help their clinical colleagues, as well as their patients, by trying to include or exclude emphysema whenever chest plates are read. Emphysema, which is a constant sequela of arrested tuberculosis, is frequently associated with sinus infection and is a serious complication in most chronic lung lesions. This serious complication is frequently overlooked to-day. Severe cases of psychoneurosis, with attacks of bronchial asthma, generally have emphysema as a base. Our text-books describe the barrel-shaped chest and cyanosis as the outstanding findings in emphysema. Cyanosis occurs either during acute attacks associated with asthma, or it is an end-result. The barrel-shaped chest is a late finding in tuberculous cases with emphysema. Before 1890 clinicians paid great attention to this condition, but little has been added to the literature since 1900. The best references for a complete study of emphysema are in “Diseases of the Lung and Pleura,” by Wilson Fox,2 which was dedicated to Sir William Jenner. It is a joy to find that Jenner's article on emphysema, in Reynolds' System of Medicine, Volume 1, published in 1871, is a classic. I have seen nothing which Jenner has not described. I am only trying to help detect upon the films in life what he found at autopsy. The x-ray diagnosis of emphysema is greatly aided by the pathology. If you have dilated air cells and thickening of pulmonary arteries, you have a pathology which increases the contrast of thoracic density. The trunks are widely separated and, on good stereoscopic films, it is easy to make out the trachea, the right and left bronchus, the pulmonary arteries, and the trunks leading to the various lobes of the lungs. It is not unusual for emphysema to be more marked in one lung than in the other; it is most striking to see emphysema more marked in an upper lobe than in another lobe of the same lung. This phenomenon can be detected easily by the greater separation of the trunks in the particular lobe involved. But let me repeat that good stereoscopic plates are a necessity and the radiologist must be familiar with the thoracic anatomy. If he is not able to locate the lobes by following the various trunks on good stereoscopic plates, he should not attempt to diagnose pulmonary emphysema. When emphysema is severe, blebs are most often seen in the bases. These lesions have been well discussed by William Snow Miller,3 after a study of a lung which I sent him, because I had made the diagnosis of emphysema from it during life. These large emphysematous areas, which are quite common, are sometimes mistaken for cavities. It was difficult for the radiologist to teach the clinician that bronchiectasis existed long before the three-layer sputum was found.