Chest distention is an increase in the volume of part or all of the chest, resulting in flattening of the diaphragm. What are its causes ? Its consequences ? How to recognize it?
Definition: what is thoracic distension?
Chest distention is enlargement of part or all of the chest. This phenomenon can be caused by a pneumothorax, a lung condition characterized by the introduction of air between the layers of the pleura (envelope that covers the lungs). An asthma attack, obstruction of a bronchus, bronchiolitis or pulmonary emphysema can also cause chest distension. The responsible cause determines the treatment to be adopted.
What are the causes of chest distention?
There are the acute causes :
► The pneumothorax which is characterized by the presence of air in the pleural cavity (the pleura are the membranes that cover and protect the lungs). The primary cause of pneumothorax in young adults is cannabis inhalation.
► Theobstruction of a bronchus by an inhaled foreign body (piece of a game, hazelnut, crumb of bread…).
► The asthma attack which often results in a chest blocked in inspiration linked to an obstruction of the bronchioles and bronchi under the action of the muscles located below the bronchi and an abnormally high secretion of mucus.
► The acute bronchiolitis which are very often associated with thoracic distension in infants due to obstruction of the bronchi by phlegm and mucus.
There are the chronic causes :
► The bronchiolitis in adults and the elderly who can be infectious or obliterating. Often chronic with outbreaks, they are observed in autoimmune diseases, including rheumatoid arthritis, transplant, smoking.
► Thepulmonary emphysema (chronic attack of the lungs which is defined by a destruction of the pulmonary alveoli and the elastic tissue which leads to a distension of the walls, there are air bubbles in the lungs and the thorax. It is mainly observed in smokers, with or without chronic obstructive pulmonary disease (COPD).
► A deficiency in the enzyme called alpha 1 antitrypsin.
What are the signs to recognize chest distension?
Chest distension is mainly manifested by:
- shortness of breath, especially on exertion,
- a cough,
- rapid and incomplete breathing in case of asthma,
- rapid and incomplete breathing in the pneumothorax,
- paleness and chest tightness.
In chronic causes, the progressively worsening shortness of breath is often associated with a chronic cough, and becomes increasingly disabling.
What are the consequences of chest distension?
“Thoracic distension is responsible for an increase in mechanical stresses: the pulmonary alveoli are distended, the small bronchi obstructed, which prevents the total expiration of air. Breathing therefore becomes more complicated. This respiratory discomfort can cause shortness of breath, hamper daily activities and lead to chronic fatigue The sooner the cause of chest distension is taken care of, the less serious the consequences will be“, says Dr. Jean-Pierre Santoni, primary prevention pulmonologist at the Fondation du Souffle.
In some cases, the diagnosis may be suspected on clinical examination because, in the presence of severe chest distention, there is a decrease in the diameter of the lower part of the thorax on inspiration. “The diagnosis is confirmed by an X-ray of the chest in front and in profile which will show a flattening of the diaphragm, the muscle which separates the rib cage from the abdomen. The radio also makes it possible to orient the cause. To assess the patient’s respiratory capacity, a pulmonary function test (LFT) is also necessary”. says the pulmonologist.
What to do in case of chest distension?
Thoracic distension must be the subject of a consultation with a pulmonologist, and depending on the case, in the emergency room. Treatment depends on the cause of chest distension and its severity. “For example, pneumothorax requires laying a drain to remove the air contained in the pleura. Bronchiolitis involves a bronchial clearance. In chronic chest distentions, bronchodilators will be used, as well as corticosteroids in the event of bronchial inflammation, respiratory physiotherapy sessions to reduce shortness of breath and in smokers the total and rapid cessation of smoking which slows down the aggravation of thoracic distension“, develops the specialist.
Thank you to Dr Jean-Philippe Santoni, primary prevention pulmonologist at the Fondation du Souffle. For more information: www.lesouffle.org