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Abstract Chest wall deformities, or abnormal development and appearance of the chest, can vary from mild to severe. These deformities are considered to be congenital and may be apparent at birth or later in childhood. Regardless, the severity of the deformity usually progresses rapidly during puberty. A variety of anomalies are described however the most common are pectus excavatum (sunken chest or funnel chest) or pectus carinatum (pigeon chest). Less common types of chest wall abnormalities including Poland’s syndrome, Jeune’s syndrome, and defects of the ribs and sternum. (Nuss et al., 1998). Since diaphragmatic motion plays a prominent role in spontaneous respiration, observation of the diaphragm kinetics seems essential. The use of tools previously available for this purpose is limited due to the associated risks of ionizing radiation (fluoroscopy, computed tomography) or due to their complex and/or highly specialized nature, requiring a skilled operator (trans-diaphragmatic pressure measurement, diaphragmatic electromyography, phrenic nerve stimulation, magnetic resonance imaging) (Ayoub et al., 2002). Cobb’s Angle” is used worldwide to measure and quantify the magnitude of spinal deformities, especially in the Summary 87 case of scoliosis. The Cobb angle measurement is the “gold standard” of scoliosis evaluation endorsed by Scoliosis Research Society. The aim of study was to Assess the diaphragmatic mobility by chest ultrasound in patients with chest deformities (developmental or acquired) with correlation of the results with the severity of the disease by measuring cobb’s angle,and spirometric variables. Chest deformity was diagnosed by chest X-ray P-A & lateral views and the severity of the deformity was determined by measuring the cobb’s angle in comparison to severity of spirometry as regard FVC(forced vital capacity). This study was carried out on 40 patients with acquired and developmental chest wall deformities. sex distribution among study population where 19 were females & 21 male, the mean±SD age was (34.93± 17.71),and Mean±SD of BMI Was (25.35± 8.57)kg/m2. And also on 20 of controlled healthy volunteers with no past medical history of cardiopulmonary disorders. Summary 88 there was no significant differences between patients and control group as regard age, sex and BMI(body mass index)the P value was less than 0.01. In the current study that carried out on 40 cases(10 kyphosis,13 kyphoscoliosis and 17 scoliosis) ,21 males and 19 females.mean age 34 ,SD34.93 ± 17.71years old and mean BMI(body mass index) 25, SD25.35 ± 8.57 Kg/m2 showing 9 cases mild, 18 moderate and 13 severe according to cobb’s angle. According to restriction severity by (FVC) mean ,SD54.80 ± 16.55 of spirometry (19 are severe,14 moderate,5 mild and 2 cases are within normal). In the current study there was no significant correlation between severity of restriction by spirometry by (forced vital capacity) and age,sex nor BMI (body mass index). This was’t matching with the results of the study carried out by Lynell C. Collins, MD 1995 who studied the Effect of Body Fat Distribution on Pulmonary Function Tests and found that FVC, FEV1, and TLC were significantly lower in the patients with upper body fat distribution (Lynell C. Collins, MD et al 1995)this difference may be due to the small number of patients with high body mass index included in this study. Summary 89 There was a significant correlation (P value was less than (0.011)) between the severity of the disease (by measureing cobb’s angle) and the age of the patients ,and a highly significant correlation between the severity of the disease and the BMI (body mass index) P value was(0.001) . These findings were close to the study carried out by Guo JM , Zhang GQ , Alimujiang who studied the Effect of BMI on lumbar lordosis and sacrum slant angle in middle and elderly women and they found that BMI exceeding 24 kg/m2 may increase the measurements of Cobb angle. (Guo JM et al2008) . There was a high significant correlation between the severity of the disease(according to cobb’s angle) and the values of pulmonary function (highly significant between severity of the disease and reduction of FVC),P value was 0.001. These findings were close to the study carried out by Amir szeinberg MD 1988 that studied the correlation between Forced vital capacity and maximal respiratory pressures in patients with mild and moderate scoliosis and he found that Lung function and maximal respiratory pressures of 24 adolescent females with mild-to-moderate idiopathic scoliosis (spinal curvature 10-60°) were determined and compared with 38 age- and sex-matched controls. Twelve patients with Summary 90 moderate scoliosis had significantly reduced mean values for FVC (% predicted) and maximal inspiratory pressure (MIP), as compared to the controls (Amir szeinberg MD 1988). In current study there was no significant correlation between the range of movement of diaphragm and age nor the body mass index of the patients ,unfortunately there wasno studies discussing this point. there was a significant correlation between the ROM(range of movement) and the side of deformity :left kyphoscoliosis (the mean of right ROM 8.3mm and mean of left ROM 9.9mm), right kyphoscoliosis( the mean of right ROM 9.9mm and mean of left ROM 7.5mm),left scoliosis (the mean of right ROM 8.6mm and mean of left ROM 9.9mm) and right scoliosis (the mean of right ROM 9.5mm and the mean of left ROM 8.6mm). There was a significant impairement in the range of movement in patient group in comparison to the control group(the mean right ROM in control group 35 mm and the mean of left ROM in control group 18.5mm).and in patient group ( the mean of right ROM 10.1mm and the mean of left ROM 9.2mm). Summary 91 Sonography receives increasing recognition as a fast, easy and accurate method of noninvasively evaluating diaphragmatic function at the bedside. (Lerolle et al., 2009). In recent years, ultrasound has also become used to evaluate diaphragmatic mobility it offers some advantages over fluoroscopy including the lack of ionizing radiation and the possibility of use at the bedside of the patient, and direct quantification of the movement of the diaphragm. So ultrasongraphy has been shown to be a promising tool in the evaluation of the diaphragm function (Sahebjami h and Gartside, 1996). |