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.

KEYWORDS

Chest wall - rib cage - kyphoscoliosis - fibrothorax - thoracoplasty - flail chest - ankylosing spondylitis - osteoporosis - mucopolysaccharidoses - hypoventilation - respiratory failure - pulmonary function

REFERENCES

• 1 Bergofsky E H. Respiratory failure in disorders of the thoracic cage.  Am Rev Respir Dis. 1979;  119 643-669
• 2 Bergofsky E H, Turino G M, Fishman A P. Cardiorespiratory failure in kyphoscoliosis.  Medicine (Baltimore). 1959;  38 263-317
• 3 Koumbourlis A C. Scoliosis and the respiratory system.  Paediatr Respir Rev. 2006;  7 152-160
• 4 Baga N, Chusid E L, Miller A. Pulmonary disability in the Klippel-Feil syndrome: a study of two siblings.  Clin Orthop Relat Res. 1969;  67 105-110
• 5 Bhagat R, Pant K, Singh V K, Pant C, Gupta A, Jaggi O P. Pulmonary developmental anomaly associated with Klippel-Feil syndrome and anomalous atrioventricular conduction.  Chest. 1992;  101 1157-1158
• 6 Suga K, Motoyama K, Hara A et al.. Respiratory failure and pulmonary hypertension associated with Klippel-Feil syndrome.  Ann Nucl Med. 1999;  13 441-446
• 7 Frick S L. Scoliosis in children with anterior chest wall deformities.  Chest Surg Clin N Am. 2000;  10 427-436
• 8 Weinstein S L, Dolan L A, Cheng J CY, Danielsson A, Morcuende J A. Adolescent idiopathic scoliosis.  Lancet. 2008;  371 1527-1537
• 9 Motosuneya T, Asazuma T, Yasuoka H, Tsuji T, Fujikawa K. Severe kyphoscoliosis associated with osteomalacia.  Spine J. 2006;  6 587-590
• 10 Jones R S, Kennedy J D, Hasham F, Owen R, Taylor J F. Mechanical inefficiency of the thoracic cage in scoliosis.  Thorax. 1981;  36 456-461
• 11 Baydur A, Swank S M, Stiles C M, Sassoon C SH. Respiratory mechanics in anesthetized young patients with kyphoscoliosis: immediate and delayed effects of corrective spinal surgery.  Chest. 1990;  97 1157-1164
• 12 van Noord J A, Cauberghs M, Van de Woestijne K P, Demedts M. Total respiratory resistance and reactance in ankylosing spondylitis and kyphoscoliosis.  Eur Respir J. 1991;  4 945-951
• 13 Conti G, Rocco M, Antonelli M et al.. Respiratory system mechanics in the early phase of acute respiratory failure due to severe kyphoscoliosis.  Intensive Care Med. 1997;  23 539-544
• 14 Kearon C, Viviani G R, Killian K J. Factors influencing work capacity in adolescent idiopathic thoracic scoliosis.  Am Rev Respir Dis. 1993;  148 295-303
• 15 Kearon C, Viviani G R, Kirkley A, Killian K J. Factors determining pulmonary function in adolescent idiopathic thoracic scoliosis.  Am Rev Respir Dis. 1993;  148 288-294
• 16 Kafer E R. Idiopathic scoliosis. Mechanical properties of the respiratory system and the ventilatory response to carbon dioxide.  J Clin Invest. 1975;  55 1153-1163
• 17 Boyer J, Amin N, Taddonio R, Dozor A J. Evidence of airway obstruction in children with idiopathic scoliosis.  Chest. 1996;  109 1532-1535
• 18 Borowitz D, Armstrong D, Cerny F. Relief of central airways obstruction following spinal release in a patient with idiopathic scoliosis.  Pediatr Pulmonol. 2001;  31 86-88
• 19 Al-Kattan K, Simonds A, Chung K F, Kaplan D K. Kyphoscoliosis and bronchial torsion.  Chest. 1997;  111 1134-1137
• 20 Weber B, Smith J P, Briscoe W A, Friedman S A, King T KC. Pulmonary function in asymptomatic adolescents with idiopathic scoliosis.  Am Rev Respir Dis. 1975;  111 389-397
• 21 Secker-Walker R H, Ho J E, Gill I S. Observations on regional ventilation and perfusion in kyphoscoliosis.  Respiration. 1979;  38 194-203
• 22 Redding G, Song K, Inscore S, Effmann E, Campbell R. Lung function asymmetry in children with congenital and infantile scoliosis.  Spine J. 2008;  8 639-644
• 23 Lisboa C, Moreno R, Fava M, Ferretti R, Cruz E. Inspiratory muscle function in patients with severe kyphoscoliosis.  Am Rev Respir Dis. 1985;  132 48-52
• 24 Kafer E R. Respiratory and cardiovascular functions in scoliosis.  Bull Eur Physiopathol Respir. 1977;  13 299-321
• 25 Noble J S, Davidson J AH. Cor pulmonale presenting in a patient with congenital kyphoscoliosis following intercontinental air travel.  Anaesthesia. 1999;  54 361-363
• 26 Herry I, Iung B, Piechaud J Y, Saidi F, Mayaud C, Boissonnas A. Cardiac cause of hypoxaemia in a kyphoscoliotic patient.  Eur Respir J. 1999;  14 1433-1434
• 27 Krachman S, Criner G J. Hypoventilation syndromes.  Clin Chest Med. 1998;  19 139-155
• 28 Shneerson J M. Respiration during sleep in neuromuscular and thoracic cage disorders.  Monaldi Arch Chest Dis. 2004;  61 44-48
• 29 Midgren B, Petersson K, Hansson L, Eriksson L, Airikkala P, Elmqvist D. Nocturnal hypoxaemia in severe scoliosis.  Br J Dis Chest. 1988;  82 226-236
• 30 Sawicka E H, Branthwaite M A. Respiration during sleep in kyphoscoliosis.  Thorax. 1987;  42 801-808
• 31 Misuri G, Lanini B, Gigliotti F et al.. Mechanism of CO(2) retention in patients with neuromuscular disease.  Chest. 2000;  117 447-453
• 32 Mezon B L, West P, Israels J, Kryger M. Sleep breathing abnormalities in kyphoscoliosis.  Am Rev Respir Dis. 1980;  122 617-621
• 33 Ellis E R, Grunstein R R, Chan S, Bye P T, Sullivan C E. Noninvasive ventilatory support during sleep improves respiratory failure in kyphoscoliosis.  Chest. 1988;  94 811-815
• 34 Guilleminault C, Kurland G, Winkle R, Miles L E. Severe kyphoscoliosis, breathing, and sleep: the “Quasimodo” syndrome during sleep.  Chest. 1981;  79 626-630
• 35 Shneerson J. Sleep in neuromuscular and thoracic cage disorders.  Eur Respir Mon. 1998;  10 324-344
• 36 Smith I E, Laroche C M, Jamieson S A, Shneerson J M. Kyphosis secondary to tuberculosis osteomyelitis as a cause of ventilatory failure: clinical features, mechanisms, and management.  Chest. 1996;  110 1105-1110
• 37 Soultanis K, Pyrovolou N, Karamitros A, Konstantinou V, Lenti A, Soucacos P N. The use of thoracoplasty in the surgical treatment of idiopathic scoliosis.  Stud Health Technol Inform. 2006;  123 327-333
• 38 Chen S H, Huang T J, Lee Y Y, Hsu R WW. Pulmonary function after thoracoplasty in adolescent idiopathic scoliosis.  Clin Orthop Relat Res. 2002;  399 152-161
• 39 Min K, Waelchli B, Hahn F. Primary thoracoplasty and pedicle screw instrumentation in thoracic idiopathic scoliosis.  Eur Spine J. 2005;  14 777-782
• 40 Suk S I, Kim J H, Kim S S, Lee J J, Han Y T. Thoracoplasty in thoracic adolescent idiopathic scoliosis.  Spine. 2008;  33 1061-1067
• 41 Upadhyay S S, Ho E K, Gunawardene W M, Leong J C, Hsu L C. Changes in residual volume relative to vital capacity and total lung capacity after arthrodesis of the spine in patients who have adolescent idiopathic scoliosis.  J Bone Joint Surg Am. 1993;  75 46-52
• 42 Newton P O, Perry A, Bastrom T P et al.. Predictors of change in postoperative pulmonary function in adolescent idiopathic scoliosis: a prospective study of 254 patients.  Spine. 2007;  32 1875-1882
• 43 Kim Y J, Lenke L G, Bridwell K H, Cheh G, Sides B, Whorton J. Prospective pulmonary function comparison of anterior spinal fusion in adolescent idiopathic scoliosis: thoracotomy versus thoracoabdominal approach.  Spine. 2008;  33 1055-1060
• 44 Chu W C, Ng B K, Li A M, Lam T P, Lam W W, Cheng J C. Dynamic magnetic resonance imaging in assessing lung function in adolescent idiopathic scoliosis: a pilot study of comparison before and after posterior spinal fusion.  J Orthop Surg. 2007;  2 20
• 45 Vedantam R, Lenke L G, Bridwell K H, Haas J, Linville D A. A prospective evaluation of pulmonary function in patients with adolescent idiopathic scoliosis relative to the surgical approach used for spinal arthrodesis.  Spine. 2000;  25 82-90
• 46 Vedantam R, Crawford A H. The role of preoperative pulmonary function tests in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion.  Spine. 1997;  22 2731-2734
• 47 Kim Y J, Lenke L G, Bridwell K H, Kim K L, Steger-May K. Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure.  J Bone Joint Surg Am. 2005;  87 1534-1541
• 48 Schwab F J, Smith V, Farcy J P. Endoscopic thoracoplasty and anterior spinal release in scoliotic deformity.  Bull Hosp Jt Dis. 2000;  59 27-32
• 49 Karami M, Ilharreborde B, Morel E, Fitoussi F, Penneçot G F, Mazda K. Video-assisted thoracoscopic surgery (VATS) for the treatment of scolioticrib hump deformity.  Eur Spine J. 2007;  16 1373-1377
• 50 Kishan S, Bastrom T, Betz R R et al.. Thoracoscopic scoliosis surgery affects pulmonary function less than thoracotomy at 2 years postsurgery.  Spine. 2007;  32 453-458
• 51 Vitale M G, Matsumoto H, Bye M R et al.. A retrospective cohort study of pulmonary function, radiographic measures, and quality of life in children with congenital scoliosis: an evaluation of patient outcomes after early spinal fusion.  Spine. 2008;  33 1242-1249
• 52 Kose N, Campbell R M. Congenital scoliosis.  Med Sci Monit. 2004;  10 RA104-RA110
• 53 Hedequist D J. Surgical treatment of congenital scoliosis.  Orthop Clin North Am. 2007;  38 497-509, vi
• 54 Gonzalez C, Ferris G, Diaz J, Fontana I, Nuñez J, Marín J. Kyphoscoliotic ventilatory insufficiency: effects of long-term intermittent positive-pressure ventilation.  Chest. 2003;  124 857-862
• 55 Gustafson T, Franklin K A, Midgren B, Pehrsson K, Ranstam J, Ström K. Survival of patients with kyphoscoliosis receiving mechanical ventilation or oxygen at home.  Chest. 2006;  130 1828-1833
• 56 Buyse B, Meersseman W, Demedts M. Treatment of chronic respiratory failure in kyphoscoliosis: oxygen or ventilation?.  Eur Respir J. 2003;  22 525-528
• 57 Vila B, Servera E, Marin J et al.. Noninvasive ventilatory assistance during exercise for patients with kyphoscoliosis: a pilot study.  Am J Phys Med Rehabil. 2007;  86 672-677
• 58 Banfi P, Redolfi S, Robert D. Home treatment of infection-related acute respiratory failure in kyphoscoliotic patients on long-term mechanical ventilation.  Respir Care. 2007;  52 713-719
• 59 Reddy R, Evans E, Khoo O, Allen M B. Pregnancy in kyphoscoliosis: benefit of non-invasive ventilatory support.  J Obstet Gynaecol. 2005;  25 267-268
• 60 Eckford S D, Veale A, Lake Y. Management of kyphoscoliosis and respiratory failure in ventilatory dependent pregnancy.  J Obstet Gynaecol. 1997;  17 374
• 61 Annane D, Orlikowski D, Chevret S, Chevrolet J C, Raphael J C. Nocturnal mechanical ventilation for chronic hypoventilation in patients with neuromuscular and chest wall disorders.  Cochrane Database Syst Rev. 2007 Oct 17;  (4) , CD001941
• 62 Rom W N, Miller A. Unexpected longevity in patients with severe kyphoscoliosis.  Thorax. 1978;  33 106-110
• 63 Giancaspro G, Soldini M, Reali A et al.. Le sequelae iatrogene della tubercolosi polmonare.  Clin Ter. 1999;  150 203-207
• 64 Jantz M A, Antony V B. Pleural fibrosis.  Clin Chest Med. 2006;  27 181-191
• 65 Doelken P, Sahn S A. Trapped lung.  Semin Respir Crit Care Med. 2001;  22 631-636
• 66 de Pablo A, Villena V, Echave-Sustaeta J, Encuentra A L. Are pleural fluid parameters related to the development of residual pleural thickening in tuberculosis?.  Chest. 1997;  112 1293-1297
• 67 Barbas C S, Cukier A, de Varvalho C R, Barbas Filho J V, Light R W. The relationship between pleural fluid findings and the development of pleural thickening in patients with pleural tuberculosis.  Chest. 1991;  100 1264-1267
• 68 Nishimura S L, Broaddus V C. Asbestos-induced pleural disease.  Clin Chest Med. 1998;  19 311-329
• 69 American Thoracic Society . Diagnosis and initial management of nonmalignant diseases related to asbestos.  Am J Respir Crit Care Med. 2004;  170 691-715
• 70 Miller A, Miller J A. Diffuse thickening superimposed on circumscribed pleural thickening related to asbestos exposure.  Am J Ind Med. 1993;  23 859-871
• 71 McLoud T C, Woods B O, Carrington C B, Epler G R, Gaensler E A. Diffuse pleural thickening in an asbestos-exposed population: prevalence and causes.  AJR Am J Roentgenol. 1985;  144 9-18
• 72 Wilson J M, Boren Jr C H, Peterson S R, Thomas A N. Traumatic hemothorax: is decortication necessary?.  J Thorac Cardiovasc Surg. 1979;  77 489-495
• 73 Lee Y CG, Vaz M AC, Ely K A et al.. Symptomatic persistent post-coronary artery bypass graft pleural effusions requiring operative treatment : clinical and histologic features.  Chest. 2001;  119 795-800
• 74 Boffa D J, Mason D P, Su J W et al.. Decortication after lung transplantation.  Ann Thorac Surg. 2008;  85 1039-1043
• 75 Sharma S, Smith R, Al-Hameed F. Fibrothorax and severe lung restriction secondary to lupus pleuritis and its successful treatment by pleurectomy.  Can Respir J. 2002;  9 335-337
• 76 Brunk J R, Drash E C, Swineford Jr O. Rheumatoid pleuritis successfully treated with decortication: report of a case and review of the literature.  Am J Med Sci. 1966;  251 545-551
• 77 Rockoff S D, Rohatgi P K. Unusual manifestations of thoracic sarcoidosis.  AJR Am J Roentgenol. 1985;  144 513-528
• 78 Maher J F. Uremic pleuritis.  Am J Kidney Dis. 1987;  10 19-22
• 79 Gilbert L, Ribot S, Frankel H et al.. Fibrinous uremic pleuritis: a surgical entity.  Chest. 1975;  67 53-56
• 80 Rodelas R, Rakowski T A, Argy W P, Schreiner G E. Fibrosing uremic pleuritis during hemodialysis.  JAMA. 1980;  243 2424-2425
• 81 Pfitzenmeyer P, Foucher P, Dennewald G et al.. Pleuropulmonary changes induced by ergoline drugs.  Eur Respir J. 1996;  9 1013-1019
• 82 Graham J R, Suby H I, LeCompte P R et al.. Fibrotic disorders associated with methysergide therapy for headache.  N Engl J Med. 1966;  274 359-368
• 83 McElvaney N G, Wilcox P G, Churg A, Fleetham J A. Pleuropulmonary disease during bromocriptine treatment of Parkinson's disease.  Arch Intern Med. 1988;  148 2231-2236
• 84 Bhatt M H, Keenan S P, Fleetham J A, Calne D B. Pleuropulmonary disease associated with dopamine agonist therapy.  Ann Neurol. 1991;  30 613-616
• 85 De Vuyst P, Pfitzenmeyer P, Camus P. Asbestos, ergot drugs and the pleura.  Eur Respir J. 1997;  10 2695-2698
• 86 Malik S W, Myers J L, DeRemee R A, Specks U. Lung toxicity associated with cyclophosphamide use: two distinct patterns.  Am J Respir Crit Care Med. 1996;  154(6 Pt 1) 1851-1856
• 87 McLoud T C, Isler R, Head J. The radiologic appearance of chemical pleurodesis.  Radiology. 1980;  135 313-317
• 88 Buchanan D R, Johnston I DA, Kerr I H, Hetzel M R, Corrin B, Turner-Warwick M. Cryptogenic bilateral fibrosing pleuritis.  Br J Dis Chest. 1988;  82 186-193
• 89 Hayes J P, Wiggins J, Ward K, Muldowney F, FitzGerald M X. Familial cryptogenic fibrosing pleuritis with Fanconi's syndrome (renal tubular acidosis): a new syndrome.  Chest. 1995;  107 576-578
• 90 Lee-Chiong Jr T L, Hilbert J. Extensive idiopathic benign bilateral asynchronous pleural fibrosis.  Chest. 1996;  109 564-565
• 91 Azoulay E, Paugam B, Heymann M F et al.. Familial extensive idiopathic bilateral pleural fibrosis.  Eur Respir J. 1999;  14 971-973
• 92 Friedman A C, Fiel S B, Radecki P D, Lev-Toaff A S. Computed tomography of benign pleural and pulmonary parenchymal abnormalities related to asbestos exposure.  Semin Ultrasound CT MR. 1990;  11 393-408
• 93 Miller A, Teirstein A S, Selikoff I J. Ventilatory failure due to asbestos pleurisy.  Am J Med. 1983;  75 911-919
• 94 Mukherjee S, de Klerk N, Palmer L J, Olsen N J, Pang S C, William Musk A. Chest pain in asbestos-exposed individuals with benign pleural and parenchymal disease.  Am J Respir Crit Care Med. 2000;  162 1807-1811
• 95 Müller N L. Imaging of the pleura.  Radiology. 1993;  186 297-309
• 96 Schmitt W GH, Hübener K H, Rücker H C. Pleural calcification with persistent effusion.  Radiology. 1983;  149 633-638
• 97 Hu H, Beckett L, Kelsey K, Christiani D. The left-sided predominance of asbestos-related pleural disease.  Am Rev Respir Dis. 1993;  148(4 Pt 1) 981-984
• 98 Churg A, Colby T V, Cagle P et al.. The separation of benign and malignant mesothelial proliferations.  Am J Surg Pathol. 2000;  24 1183-1200
• 99 Leung A N, Müller N L, Miller R R. CT in differential diagnosis of diffuse pleural disease.  AJR Am J Roentgenol. 1990;  154 487-492
• 100 Liu C T, Cellerino A, Baldi S et al.. Pulmonary function in patients with pleural effusion of varying magnitude and fibrothorax.  Panminerva Med. 1991;  33 86-92
• 101 Bolliger C T, de Kock M A. Influence of a fibrothorax on the flow/volume curve.  Respiration. 1988;  54 197-200
• 102 Wright P H, Hanson A, Kreel L, Capel L H. Respiratory function changes after asbestos pleurisy.  Thorax. 1980;  35 31-36
• 103 McGavin C R, Sheers G. Diffuse pleural thickening in asbestos workers: disability and lung function abnormalities.  Thorax. 1984;  39 604-607
• 104 Cotes J E, King B. Relationship of lung function to radiographic reading (ILO) in patients with asbestos related lung disease.  Thorax. 1988;  43 777-783
• 105 Rosenstock L, Barnhart S, Heyer N J, Pierson D J, Hudson L D. The relation among pulmonary function, chest roentgenographic abnormalities, and smoking status in an asbestos-exposed cohort.  Am Rev Respir Dis. 1988;  138 272-277
• 106 Schwartz D A. New developments in asbestos-induced pleural disease.  Chest. 1991;  99 191-198
• 107 Kilburn K H, Warshaw R. Pulmonary functional impairment associated with pleural asbestos disease: circumscribed and diffuse thickening.  Chest. 1990;  98 965-972
• 108 Schwartz D A, Galvin J R, Dayton C S, Stanford W, Merchant J A, Hunninghake G W. Determinants of restrictive lung function in asbestos-induced pleural fibrosis.  J Appl Physiol. 1990;  68 1932-1937
• 109 Singh B, Eastwood P R, Finucane K E, Panizza J A, Musk A W. Effect of asbestos-related pleural fibrosis on excursion of the lower chest wall and diaphragm.  Am J Respir Crit Care Med. 1999;  160(5 Pt 1) 1507-1515
• 110 Ohlson C G, Bodin L, Rydman T, Hogstedt C. Ventilatory decrements in former asbestos cement workers: a four year follow up.  Br J Ind Med. 1985;  42 612-616
• 111 Bourbeau J, Ernst P, Chrome J, Armstrong B, Becklake M R. The relationship between respiratory impairment and asbestos-related pleural abnormality in an active work force.  Am Rev Respir Dis. 1990;  142 837-842
• 112 Yates D H, Browne K, Stidolph P N, Neville E. Asbestos-related bilateral diffuse pleural thickening: natural history of radiographic and lung function abnormalities.  Am J Respir Crit Care Med. 1996;  153 301-306
• 113 Picado C, Laporta D, Grassino A, Cosio M, Thibodeau M, Becklake M R. Mechanisms affecting exercise performance in subjects with asbestos-related pleural fibrosis.  Lung. 1987;  165 45-57
• 114 Howard J, Mohsenifar Z, Brown H V, Koerner S K. Role of exercise testing in assessing functional respiratory impairment due to asbestos exposure.  J Occup Med. 1982;  24 685-689
• 115 Shih J F, Wilson J S, Broderick A et al.. Asbestos-induced pleural fibrosis and impaired exercise physiology.  Chest. 1994;  105 1370-1376
• 116 Dewan R K, Singh S, Kumar A, Meena B K. Thoracoplasty: an obsolete procedure?.  Indian J Chest Dis Allied Sci. 1999;  41 83-88
• 117 Addor G, Monteiro A S, Nigri D H, Judice L F, Haddad R, Franco C A. Trauma-related thoracoplasty: case report.  J Bras Pneumol. 2007;  33 351-354
• 118 Icard P, Le Rochais J P, Rabut B, Cazaban S, Martel B, Evrard C. Andrews thoracoplasty as a treatment of post-pneumonectomy empyema: experience in 23 cases.  Ann Thorac Surg. 1999;  68 1159-1163 discussion 1164
• 119 Phillips M S, Kinnear W JM, Shneerson J M. Late sequelae of pulmonary tuberculosis treated by thoracoplasty.  Thorax. 1987;  42 445-451
• 120 Phillips M S, Miller M R, Kinnear W JM, Gough S E, Shneerson J M. Importance of airflow obstruction after thoracoplasty.  Thorax. 1987;  42 348-352
• 121 Huang C T, Lyons H A. Cardiorespiratory failure in patients with pneumonectomy for tuberculosis: long-term effects of thoracoplasty.  J Thorac Cardiovasc Surg. 1977;  74 409-417
• 122 Bredin C P. Pulmonary function in long-term survivors of thoracoplasty.  Chest. 1989;  95 18-20
• 123 Loynes R D. Scoliosis after thoracoplasty.  J Bone Joint Surg Br. 1972;  54 484-498
• 124 Hauge B N. Diaphragmatic movement and spirometric volume in patients with one functioning lung.  Scand J Respir Dis. 1971;  52 84-99
• 125 Moore N R, Phillips M S, Shneerson J M, Flower C DR, Dixon A K. Pleural thickening and skeletal deformity in thoracoplasty: the relationship to ventilatory failure [abstract].  Thorax. 1986;  41 717
• 126 Shiraishi K, Sasaki H, Yaekashiwa M, Motomiya M, Nukiwa T. Total respiratory system compliance after thoracoplasty.  Respir Med. 1998;  92 810-814
• 127 O'Connor T M, O'Riordan D M, Stack M, Bredin C P. Airways obstruction in survivors of thoracoplasty: reversibility is greater in non-smokers.  Respirology. 2004;  9 130-133
• 128 Pettiford B L, Luketich J D, Landreneau R J. The management of flail chest.  Thorac Surg Clin. 2007;  17 25-33
• 129 Borrelly J, Aazami M H. New insights into the pathophysiology of flail segment: the implications of anterior serratus muscle in parietal failure.  Eur J Cardiothorac Surg. 2005;  28 742-749
• 130 LoCicero III J, Mattox K L. Epidemiology of chest trauma.  Surg Clin North Am. 1989;  69 15-19
• 131 Fulton R L, Peter E T, Wilson J N. The pathophysiology and treatment of pulmonary contusions.  J Trauma. 1970;  10 719-730
• 132 Garzon A A, Gourin A, Seltzer B, Chiu C J, Karlson K E. Severe blunt chest trauma. Studies of pulmonary mechanics and blood gases.  Ann Thorac Surg. 1966;  2 629-639
• 133 Garzon A A, Seltzer B, Karlson K E. Physiopathology of crushed chest injuries.  Ann Surg. 1968;  168 128-136
• 134 Livingston D H, Shogan B, John P, Lavery R F. CT diagnosis of rib fractures and the prediction of acute respiratory failure.  J Trauma. 2008;  64 905-911
• 135 Schweiger J. The pathophysiology, diagnosis and management strategies for flail chest injury and pulmonary contusion: a review.  Anesth Analg. 2001;  92(suppl 3) S86-S93
• 136 Erickson D R, Shinozaki T, Beekman E, Davis J H. Relationship of arterial blood gases and pulmonary radiographs to the degree of pulmonary damage in experimental pulmonary contusion.  J Trauma. 1971;  11 689-694
• 137 Johannigman J A, Campbell R S, Davis Jr K, Hurst J M. Combined differential lung ventilation and inhaled nitric oxide therapy in the management of unilateral pulmonary contusion.  J Trauma. 1997;  42 108-111
• 138 Shapiro M B, Anderson III H L, Bartlett R H. Respiratory failure. Conventional and high-tech support.  Surg Clin North Am. 2000;  80(3) 871-883
• 139 Kause J, Parr M. Extracorporeal membrane oxygenation in the management of severe thoracic trauma: a case report.  Crit Care Resusc. 2001;  3 97-100
• 140 Hurst J M, DeHaven C B, Branson R D. Use of CPAP mask as the sole mode of ventilatory support in trauma patients with mild to moderate respiratory insufficiency.  J Trauma. 1985;  25 1065-1068
• 141 Tanaka H, Tajimi K, Endoh Y, Kobayashi K. Pneumatic stabilization for flail chest injury: an 11-year study.  Surg Today. 2001;  31 12-17
• 142 Gunduz M, Unlugenc H, Ozalevli M, Inanoglu K, Akman H. A comparative study of continuous positive airway pressure (CPAP) and intermittent positive pressure ventilation (IPPV) in patients with flail chest.  Emerg Med J. 2005;  22 325-329
• 143 Voggenreiter G, Neudeck F, Aufmkolk M, Obertacke U, Schmit-Neuerburg K P. Operative chest wall stabilization in flail chest: outcomes of patients with or without pulmonary contusion.  J Am Coll Surg. 1998;  187 130-138
• 144 Ahmed Z, Mohyuddin Z. Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation.  J Thorac Cardiovasc Surg. 1995;  110 1676-1680
• 145 Athanassiadi K, Gerazounis M, Theakos N. Management of 150 flail chest injuries: analysis of risk factors affecting outcome.  Eur J Cardiothorac Surg. 2004;  26 373-376
• 146 Tanaka H, Yukioka T, Yamaguti Y et al.. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients.  J Trauma. 2002;  52 727-732, discussion 732
• 147 Slater M S, Mayberry J C, Trunkey D D. Operative stabilization of a flail chest six years after injury.  Ann Thorac Surg. 2001;  72 600-601
• 148 Salaffi F, De Angelis R, Grassi W. MArche Pain Prevalence . Prevalence of musculoskeletal conditions in an Italian population sample: results of a regional community-based study, I: The MAPPING study.  Clin Exp Rheumatol. 2005;  23 819-828
• 149 Schlossbauer T, Becker-Gaab C, Eibel R. Pulmonale Manifestationen bei Erkrankungen des rheumatischen Formenkreises.  Radiologe. 2005;  45 649-664
• 150 Fraser R G, Pare J A, Pare P D, Fraser R S, Genereux G P. Diagnosis of Diseases of the Chest. 3rd ed. Philadelphia, PA; WB Saunders 1991
• 151 Fournie B, Boutes A, Dromer C et al.. Prospective study of anterior chest wall involvement in ankylosing spondylitis and psoriatic arthritis.  Rev Rhum Engl Ed. 1997;  64 22-25
• 152 Guglielmi G, Scalzo G, Cascavilla A, Salaffi F, Grassi W. Imaging of the seronegative anterior chest wall (ACW) syndromes.  Clin Rheumatol. 2008;  27 815-821
• 153 Altin R, Ozdolap S, Savranlar A et al.. Comparison of early and late pleuropulmonary findings of ankylosing spondylitis by high-resolution computed tomography and effects on patients' daily life.  Clin Rheumatol. 2005;  24 22-28
• 154 Rosenow E C, Strimlan C V, Muhm J R, Ferguson R H. Pleuropulmonary manifestations of ankylosing spondylitis.  Mayo Clin Proc. 1977;  52 641-649
• 155 Sampaio-Barros P D, Cerqueira E MFP, Rezende S M et al.. Pulmonary involvement in ankylosing spondylitis.  Clin Rheumatol. 2007;  26 225-230
• 156 Souza Jr A S, Müller N L, Marchiori E, Soares-Souza L V, de Souza Rocha M. Pulmonary abnormalities in ankylosing spondylitis: inspiratory and expiratory high-resolution CT findings in 17 patients.  J Thorac Imaging. 2004;  19 259-263
• 157 Dincer U, Cakar E, Kiralp M Z, Bozkanat E, Kilac H, Dursun H. The pulmonary involvement in rheumatic diseases: pulmonary effects of ankylosing spondylitis and its impact on functionality and quality of life.  Tohoku J Exp Med. 2007;  212 423-430
• 158 Ayhan-Ardic F F, Oken O, Yorgancioglu Z R, Ustun N, Gokharman F D. Pulmonary involvement in lifelong non-smoking patients with rheumatoid arthritis and ankylosing spondylitis without respiratory symptoms.  Clin Rheumatol. 2006;  25 213-218
• 159 Kiris A, Ozgocmen S, Kocakoc E, Ardicoglu O, Ogur E. Lung findings on high resolution CT in early ankylosing spondylitis.  Eur J Radiol. 2003;  47 71-76
• 160 Cerrahoglu L, Unlu Z, Can M, Goktan C, Celik P. Lumbar stiffness but not thoracic radiographic changes relate to alteration of lung function tests in ankylosing spondylitis.  Clin Rheumatol. 2002;  21 275-279
• 161 Aggarwal A N, Gupta D, Wanchu A, Jindal S K. Use of static lung mechanics to identify early pulmonary involvement in patients with ankylosing spondylitis.  J Postgrad Med. 2001;  47 89-94
• 162 Feltelius N, Hedenström H, Hillerdal G, Hällgren R. Pulmonary involvement in ankylosing spondylitis.  Ann Rheum Dis. 1986;  45 736-740
• 163 Fisher L R, Cawley M ID, Holgate S T. Relation between chest expansion, pulmonary function, and exercise tolerance in patients with ankylosing spondylitis.  Ann Rheum Dis. 1990;  49 921-925
• 164 Vanderschueren D, Decramer M, Van den Daele P, Dequeker J. Pulmonary function and maximal transrespiratory pressures in ankylosing spondylitis.  Ann Rheum Dis. 1989;  48 632-635
• 165 Sahin G, Guler H, Calikoglu M, Sezgin M. Vergleich der Atemmuskelkraft, Lungenfunktionstests und Ausdauer bei Patienten mit ankylosierender Spondylitis im Fruh- bzw. Spatstadium.  Z Rheumatol. 2006;  65 535-540
• 166 Koseoglu F, Ozel S, Demirdeviren S, Karabiyikoglu G, Yorgancioglu R. Effects of a pulmonary rehabilitation program on pulmonary functions, cycle ergometry test- parameters, exercise tolerance, and spinal mobility in patients with ankylosing spondylitis.  Eur J Phys Rehabil Med. 1998;  8 67-70
• 167 Sahin G, Calikoğlu M, Ozge C et al.. Respiratory muscle strength but not BASFI score relates to diminished chest expansion in ankylosing spondylitis.  Clin Rheumatol. 2004;  23 199-202
• 168 Josenhans W T, Wang C S. A modified ballistic method for measuring axial mass displacement caused by breathing.  J Appl Physiol. 1970;  28 679-684
• 169 Josenhans W T, Wang C S, Josenhans G, Woodbury J FL. Diaphragmatic contribution to ventilation in patients with ankylosing spondylitis.  Respiration. 1971;  28 331-346
• 170 Grimby G, Fugl-Meyer A R, Blomstrand A. Partitioning of the contributions of rib cage and abdomen to ventilation in ankylosing spondylitis.  Thorax. 1974;  29 179-184
• 171 Ferrigno G, Carnevali P. Principal component analysis of chest wall movement in selected pathologies.  Med Biol Eng Comput. 1998;  36 445-451
• 172 Romagnoli I, Gigliotti F, Galarducci A et al.. Chest wall kinematics and respiratory muscle action in ankylosing spondylitis patients.  Eur Respir J. 2004;  24 453-460
• 173 Ragnarsdottir M, Geirsson A J, Gudbjornsson B. Rib cage motion in ankylosing spondylitis patients: a pilot study.  Spine J. 2008;  8 505-509
• 174 Elliott C G, Hill T R, Adams T E, Crapo R O, Nietrzeba R M, Gardner R M. Exercise performance of subjects with ankylosing spondylitis and limited chest expansion.  Bull Eur Physiopathol Respir. 1985;  21 363-368
• 175 Carter R, Riantawan P, Banham S W, Sturrock R D. An investigation of factors limiting aerobic capacity in patients with ankylosing spondylitis.  Respir Med. 1999;  83 L700-L708
• 176 van der Esch M, van 't Hul A J, Heijmans M, Dekker J. Respiratory muscle performance as a possible determinant of exercise capacity in patients with ankylosing spondylitis.  Aust J Physiother. 2004;  50 41-45
• 177 Seçkin U, Bölükbasi N, Gürsel G, Eröz S, Sepici V, Ekim N. Relationship between pulmonary function and exercise tolerance in patients with ankylosing spondylitis.  Clin Exp Rheumatol. 2000;  18 503-506
• 178 Raber A, Seilheimer D K. Pectus carinatum. UpToDate 2006
• 179 Coelho Mde S, Guimaraes Pde S. Pectus carinatum.  J Bras Pneumol. 2007;  33 463-474
• 180 Malek M H, Berger D E, Marelich W D, Coburn J W, Beck T W, Housh T J. Pulmonary function following surgical repair of pectus excavatum: a meta-analysis.  Eur J Cardiothorac Surg. 2006;  30 637-643
• 181 Schlaich C, Minne H W, Bruckner T et al.. Reduced pulmonary function in patients with spinal osteoporotic fractures.  Osteoporos Int. 1998;  8 261-267
• 182 Harrison R A, Siminoski K, Vethanayagam D, Majumdar S R. Osteoporosis-related kyphosis and impairments in pulmonary function: a systematic review.  J Bone Miner Res. 2007;  22 447-457
• 183 Ordu Gokkaya N K, Koseoglu F, Albayrak N. Reduced aerobic capacity in patients with severe osteoporosis: a cross sectional study.  Eur J Phys Rehabil Med. 2008;  44 141-147
• 184 Yang H L, Zhao L, Liu J et al.. Changes of pulmonary function for patients with osteoporotic vertebral compression fractures after kyphoplasty.  J Spinal Disord Tech. 2007;  20 221-225
• 185 Tanigawa N, Kariya S, Kojima H et al.. Improvement in respiratory function by percutaneous vertebroplasty.  Acta Radiol. 2008;  49 638-643
• 186 Cimen O B, Ulubaş B, Sahin G, Calikoğlu M, Bağiş S, Erdoğan C. Pulmonary function tests, respiratory muscle strength, and endurance of patients with osteoporosis.  South Med J. 2003;  96 423-426
• 187 Lombardi Jr I, Oliveira L M, Mayer A F, Jardim J R, Natour J. Evaluation of pulmonary function and quality of life in women with osteoporosis.  Osteoporos Int. 2005;  16 1247-1253
• 188 Black P N, Scragg R. Relationship between serum 25-hydroxyvitamin d and pulmonary function in the third national health and nutrition examination survey.  Chest. 2005;  128 3792-3798
• 189 Ragucci M, Vainrib A. Pulmonary rehabilitation for restrictive lung impairment secondary to osteoporotic sternal fracture: a case report.  Arch Phys Med Rehabil. 2005;  86 1487-1488
• 190 Kakkis E, Wraith E. Clinical features and diagnosis of the mucopolysaccharidoses. UpToDate 2007
• 191 Semenza G L, Pyeritz R E. Respiratory complications of mucopolysaccharide storage disorders.  Medicine (Baltimore). 1988;  67 209-219
• 192 Murray J F. Pulmonary disability in the Hurler syndrome (lipochondrodystrophy): a study of two cases.  N Engl J Med. 1959;  261 378-382
• 193 Kamin W. Diagnosis and management of respiratory involvement in Hunter syndrome.  Acta Paediatr Suppl. 2008;  97 57-60
• 194 Hope E O, Farebrother M J, Bainbridge D. Some aspects of respiratory function in three siblings with Morquio-Brailsford disease.  Thorax. 1973;  28 335-341
• 195 Buhain W J, Rammohan G, Berger H W. Pulmonary function in Morquio's disease: A study of two siblings.  Chest. 1975;  68 41-45
• 196 Pritzker M R, King R A, Kronenberg R S. Upper airway obstruction during head flexion in Morquio's disease.  Am J Med. 1980;  69 467-470
• 197 Santamaria F, Andreucci M V, Parenti G et al.. Upper airway obstructive disease in mucopolysaccharidoses: polysomnography, computed tomography and nasal endoscopy findings.  J Inherit Metab Dis. 2007;  30 743-749
• 198 Buhain W J, Rammohan G, Berger H W. Pulmonary function in myositis ossificans progressiva.  Am Rev Respir Dis. 1974;  110 333-337
• 199 Huseby J S, Petersen D. Pulmonary function in Klinefelter's syndrome.  Chest. 1981;  80 31-33