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Respiratory Exam

Chest Deformities



Chest wall deformities may be an external sign of an underlying disease, or may themselves cause significant restrictive pulmonary disease.

Barrel Chest

  • Look For

  • A rounded, bulging chest.
  • Causes of Barrel Chest

  • Physiological
  • Hyperinflation - acute asthma, late emphysema
  • Osteoarthritis

Pectus Excavatum

Also known as funnel chest.
  • Look For

  • Inward depression of the sternum.
  • Causes of Pectus Excavatum

  • Marfan syndrome
  • Congenital heart diseases

Pectus Carinatum

Also known as pigeon chest.
  • Look For

  • Forward angulation of the sternum
  • Causes of Pectus Carinatum

  • Marfan syndrome
  • Down syndrome


  • How to Elicit

  • Inspect the spine, and then palpate the spinous processes of the vertebrae.
  • Look For

  • Lateral curvature of the spine
  • Distortion of the trunk
  • Prominence of the ribs
  • Asymmetry of skin folds around the flank
  • Shoulder elevation
  • Scapular rotation
  • Causes of Scoliosis

  • Idiopathic (80%)
  • Congenital - maldevelopment of vertebrae
  • Neuromuscular disorders - cerebral palsy, muscular dystrophy
  • Syndromal - Marfan, neurofibromatosis, Down syndrome
  • Trauma - fracture, dislocation, burns
  • Degenerative - secondary to facet joint osteoarthritis
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