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Respiratory Diseases
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Physical signs may not be evident until disease is severe. They include ‘barrel chest’ due to hyperinflation, hyper-resonance (on percussion), overall decreased breath sounds throughout the lung fields, wheezing, coarse crackles, prolonged expiration, accessory muscle use and pursed-lip breathing.
The respiratory system
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
There is a wide variation in chest shape among healthy individuals, and the only way to become familiar with the normal range is to examine a large number of patients. The normal antero-posterior diameter of the chest should be less than the lateral diameter. The chest wall may be held in hyperinflation and ‘remodelled’ – a barrel chest – as a result of chronic airflow limitation. This improves the elastic recoil of the lungs, but at the expense of raised lung volumes. Apical fibrosis and scarring may result in flattening of the chest at one or both apices.
The Lung Channel (LU)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Clinical Relevance: Inadequate lung expansion or air expulsion as in asthmatic individuals. Caution required in all patients, especially those with local muscle atrophy or hyperexpansion of lungs (“barrel chest”).
Secondary erythrocytosis
Published in Expert Review of Hematology, 2023
Rodrick Babakhanlou, Srdan Verstovsek, Naveen Pemmaraju, Cristhiam M. Rojas-Hernandez
Although measurement of arterial oxygen saturation (SaO2) is a sensitive indicator of tissue hypoxia, results should be interpreted with caution in patients with carbon monoxide poisoning or sleep apnea, as results can be misleading [6]. Cardiac auscultation may reveal the presence of murmurs or abnormal heart sounds, which can be suggestive of an underlying cardiac condition with a right-to-left shunt [1]. The presence of clubbing of the fingers, decreased breath sounds, and the presence of a barrel chest may indicate emphysematous changes of the lung [1]. Abdominal examination should focus on the presence of any mass, as various benign and malignant tumors can give rise to secondary erythrocytosis as a paraneoplastic manifestation [1].
Stereotactic body radiotherapy in patients with multiple lung tumors: a focus on lung dosimetric constraints
Published in Expert Review of Anticancer Therapy, 2019
Michael T. Milano, Alina Mihai, John Kang, Deepinder P Singh, Vivek Verma, Haoming Qiu, Yuhchyau Chen, Feng-Ming (Spring) Kong
The complementary volume metrics are advantageous in evaluating lung exposure from multiple targets, as they reflect the amount of lung that is relatively spared from radiation, or receiving a dose at a level of causing no notable changes in lung function. Nevertheless, it is not known what is more predictive of toxicity: lung exposed to radiation (Vx, MLD; Figure 2) or absolute volume of lung spared from radiation (critical volume; Figure 3). It may be that both serve separate purposes depending on the toxicity of concern. For predicting risks of compromised lung function, the complementary volume metrics are logical: sparing tissue in an OAR with a parallel arrangement of functional subunits should spare function. For radiation pneumonitis, which reflects radiation-induced tissue injury and an inflammatory reaction [24], complementary volume metrics may not be as useful, since tissue injury and inflammation are likely a function of volume receiving the high dose. Additionally, complementary volume measures, using absolute volumes for critical volume thresholds, depend heavily upon total lung volume, which can vary widely between patients. For example, a tall patient with chronic obstructive pulmonary disease, flat diaphragms, and a barrel chest would have a markedly larger total lung volume than a patient with short stature and restrictive lung disease due to obesity. For a given lung V20, the critical volume constraints (with absolute volume) will be more readily met in patients with relatively larger total lung volumes (Figure 4). The complementary volume metrics appear to not be as widely used in the literature (and therefore perhaps not used as much in clinical practice); notably, the HyTEC authors’ pooled analyses of lung toxicity [6] primarily identified studies that analyzed lung Vx and MLD, but not complementary volume. Additionally, not all lung volumes are functional or function equally.