Chest
Volume 111, Issue 4, April 1997, Pages 1134-1137
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Selected Reports
Kyphoscoliosis and Bronchial Torsion

https://doi.org/10.1378/chest.111.4.1134Get rights and content

Study objective

Severe idiopathic scoliosis is associated with respiratory failure. This usually is secondary to restrictive airway disease and reduced vital capacity. Patients may also suffer from an increase in airway resistance when severe kyphoscoliosis is present.

Setting

Three patients (two of whom required assisted ventilation) with varying degrees of kyphoscoliosis presented with moderate to severe breathing difficulties.

Intervention

Bronchoscopic examination of these patients showed evidence of torsion with secondary obstruction of the central airways.

Results

The airway obstruction was notable for its slit-like appearance, for the normality of the mucosa at the site of the obstruction, for the relative ease through which an instrument could traverse the obstruction, and once the retained secretions had been cleared, for the preservation of normal anatomy of the distal airways. The insertion of metal prostheses to stent the areas of obstruction prompted an impressive improvement in respiratory status, radiologic findings, and spirometric criteria in each case. Improvement has been maintained over a maximum follow-up period of 4 years.

Conclusion

Severe kyphoscoliosis can lead to bronchial torsion and obstruction of the central airways. Patients should be assessed by bronchoscopy to exclude this deformity or any other cause of obstruction. The use of a metal endobronchial stent has been effective in both the immediate and long-term period.

Section snippets

Case 1

A 40-year-old woman had gross congenital kyphoscoliosis and cor pulmonale leading to type 2 respiratory failure. The patient required assisted mechanical support in the form of nasal intermittent ventilation. Recurrent bouts of respiratory infection necessitated admission to the hospital on a nearly bimonthly basis. There was auscultatory and radiologic evidence of collapse of the lower and middle lobes of the right lung (Fig 1). Bronchoscopic appearance revealed complete obstruction of the

Comment

Severe kyphoscoliosis is associated with respiratory complications, often leading to respiratory failure. The progressive nature of the disease limits the vital capacity and chest wall compliance of the patients with the effect of normal changes with age. The reduced vital capacity and the severity of the scoliosis are the most important predicting factors in prognosis.1 Superinfection and muscle weakness also influence the respiratory function because of an increased work of breathing in those

References (12)

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