Breathing Sounds and Pain in Pectus Excavatum Patients - Pulmonology

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Understanding breathing sounds and pain in patients with pectus excavatum can be quite complex, as this condition can affect the mechanics of breathing and the overall function of the thoracic cavity. Pectus excavatum, commonly referred to as funnel chest, is a congenital deformity characterized by a sunken sternum and rib cage, which can lead to various respiratory and cardiovascular issues.


Breathing Sounds and Mechanics
In patients with pectus excavatum, the altered shape of the chest wall can lead to changes in airflow dynamics. When you mention that you hear breathing sounds when your mouth is open and your upper body is turning, this could be attributed to several factors:
1. Airflow Turbulence: The abnormal structure of the thoracic cavity may cause turbulence in airflow, especially during movements that change the position of the rib cage and diaphragm. This turbulence can create audible sounds during inhalation or exhalation.

2. Increased Work of Breathing: Patients with pectus excavatum may experience increased work of breathing due to the restricted space for lung expansion. This can lead to compensatory mechanisms, such as using accessory muscles for breathing, which may also contribute to unusual sounds.

3. Respiratory Muscle Fatigue: If the respiratory muscles are overworked due to the mechanical disadvantage posed by the chest deformity, it may lead to fatigue, which can manifest as altered breathing patterns and sounds.


Pain in the Rib Area
The sharp pain you experience in the area of the right lower rib or the left side, particularly around the concave region of the chest, can be attributed to several potential causes:
1. Musculoskeletal Strain: The altered mechanics of breathing and the use of accessory muscles can lead to strain on the muscles and ligaments surrounding the rib cage. This strain can result in localized pain, especially during movements that require more effort from these muscles.

2. Nerve Irritation: The position of the ribs and sternum in pectus excavatum can sometimes lead to irritation of the intercostal nerves, which run between the ribs. This irritation can cause sharp, stabbing pain in the affected areas.

3. Costochondritis: Inflammation of the cartilage connecting the ribs to the sternum (costochondritis) can occur in individuals with pectus excavatum, leading to localized pain that may be exacerbated by movement or deep breathing.

4. Underlying Pulmonary Issues: Although less common, it is essential to rule out any underlying pulmonary issues, such as atelectasis (partial lung collapse) or pleuritis (inflammation of the pleura), which could also contribute to pain and abnormal breathing sounds.


Recommendations for Evaluation
Given your symptoms, it is advisable to seek a thorough evaluation from a healthcare professional, preferably a pulmonologist or a thoracic surgeon familiar with pectus excavatum. They may recommend the following assessments:
1. Pulmonary Function Tests (PFTs): These tests can help evaluate the functional capacity of your lungs and determine if there is any significant impairment in airflow or lung volume.

2. Imaging Studies: A chest X-ray or CT scan can provide detailed images of the thoracic cavity, allowing for assessment of the degree of pectus excavatum and any associated structural abnormalities.

3. Physical Examination: A thorough physical examination can help identify any musculoskeletal issues contributing to your pain and breathing sounds.

4. Referral to Physical Therapy: If musculoskeletal strain is identified, a physical therapist can provide exercises to strengthen the respiratory muscles and improve overall breathing mechanics.


Conclusion
In summary, the breathing sounds and pain you are experiencing may indeed be related to your pectus excavatum. The altered mechanics of your thoracic cavity can lead to turbulence in airflow and strain on respiratory muscles, resulting in discomfort. It is crucial to consult with a healthcare professional for a comprehensive evaluation to address your symptoms effectively and to rule out any serious underlying conditions.