An Overview of Barrel Chest

closeup of a young caucasian doctor man sitting at his office desk observing a chest radiograph in a tablet computer

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Barrel chest is a generalized description of what you likely imagine—a rounded, bulging chest that is similar in shape to a barrel. While not technically a medical term, barrel chest is often used by doctors to describe a physical characteristic consistent with cases of late-stage emphysema, in which the chest may become fixed in an outward position. Barrel chest can also occur with cystic fibrosis, severe asthma, and other health issues.

Symptoms

Barrel chest occurs when the lungs become chronically overinflated (hyperinflated) with air, forcing the rib cage to stay expanded for long periods of time.

Over time, the distention of the rib cage will not only affect the anterior (forward-facing) chest wall, but the posterior (back-facing) wall as well. As muscle wasting develops—which is often seen in later-stage emphysema—the loss of external support further promotes the deformity.

Barrel chest itself is not usually painful but may serve as a sign of severe underlying lung disease or damage.

Symptoms and signs often associated with barrel chest include:

  • Difficulty breathing
  • Shortness of breath
  • Stiffness
  • Reduced oxygen saturation level
  • High levels of carbon dioxide in the bloodstream
  • Limited ability to exercise
  • Posture changes

Causes

Lung damage and lung disease are the typical causes of barrel chest in adults, but there are also genetic, environmental, and aging-related factors, too, many of which are not fully reversible. Exceptions to that include children who have cystic fibrosis or severe asthma; in these cases, barrel chest may be somewhat reversible.

Emphysema

Emphysema is one of the two diseases that comprise chronic obstructive pulmonary disease (COPD). It is typically accompanied by chronic bronchitis, an inflammatory condition characterized by the narrowing of the airways and the excessive production of mucus.

Emphysema specifically refers to the destruction of the air sacs of the lung, called alveoli. These are tiny organs at the end of air passages through which oxygen is transferred to the blood and carbon dioxide is extracted.

With fewer and fewer alveoli available to facilitate gas exchange, the lungs have to work harder and take deeper and longer inhalations. As the condition progresses, the lungs will tend to remain in a hyperinflated state, leaving the rib cage expanded.

With emphysema, the depth-to-width proportion of the chest will typically increase from 1:2 (normal size) to 1:1 (barrel chest). Moreover, as the posterior bulging progresses, the spine will be pushed back as the shoulders roll forward, creating a stooped posture.

Osteoarthritis

Osteoarthritis, also known as "wear-and-tear arthritis," typically affects the hands, neck, lower back, knees, and hips.

It can also cause progressive damage to the middle back and thorax. The condition, referred to as thoracic arthritis, is caused by the degeneration of the cartilage and bone of the middle spine. As the joint bones start to compress and rub against each other, the ensuing inflammation can trigger the overproduction of bone tissue and the gradual malformation of the spine.

As muscle loss further weakens the external support, the rib cage can develop a splayed, barrel-like appearance that can eventually become permanent as the joint bones fuse. Low calcium levels can further accelerate the problem, causing deformity of the sternum and a condition known as dorsal kyphosis, in which the back becomes rounded and hunched.

Cystic Fibrosis

Cystic fibrosis often causes a barrel chest in children and younger adults affected by the disease. The inheritable genetic disorder triggers the overproduction of mucus, clogging the alveoli and restricting the amount of air entering the lungs.

Over time, the exertion needed to fill the lungs can cause air to become trapped, leaving the chest in a partially inflated position. As a chronic, irreversible condition, cystic fibrosis requires constant surveillance to help clear the lungs and prevent hyperinflation.

Severe Asthma

Severe asthma is a common cause of barrel chest in children. As opposed to cystic fibrosis, in which the air passages become clogged, asthma causes the passages to constrict and narrow.

When asthma symptoms are severe, the passages are in a persistently narrowed state (in some cases, even after bronchodilators are used). As the air in the lungs becomes trapped and unable to escape, a child's chest can take on a barrel-like appearance (in part, because the cartilage of the rib cage is still so flexible).

Genetic Disorders

While some people are born with larger rib cages, there are rare genetic disorders for which barrel chests are characteristic.

One such example is Dyggve-Melchior-Clausen (DMC) syndrome, a rare, progressive condition characterized by short stature, skeletal deformity, and microcephaly (an abnormally small head). DMC syndrome is so rare that only around 100 cases have been reported.

Sialidosis, also known as mucolipidosis type 2, is another rare disorder. It is characterized by the abnormal accumulation of toxic substances in the body. Symptoms usually develop during infancy or later childhood and may include short stature, barrel chest, mild cognitive impairment, and cherry-red spots on the eyes.

Spondyloepiphyseal dysplasia tarda is a rare, hereditary disorder. Symptoms tend to appear between the ages of 6 and 10, and include short stature, spinal deformity, barrel chest, and premature osteoarthritis.

Any skeletal malformations resulting from these disorders are considered permanent.

Extreme Altitudes

Because the air is thinner in extremely high altitudes, the lungs have to work harder to maintain the exchange of oxygen and carbon dioxide. As such, people who live in areas higher than 16,500 feet will almost invariably have evidence of a barrel chest.

While there are only a handful of formal communities that meet this criterion—among them, La Rinconada in Peru (16,830 feet) and Tuiwa in Tibet (16,630 feet)—there are informal settlements that are situated ever higher.

While visiting high altitudes will not cause barrel chest, the thorax may appear larger as you expand the chest to take in deeper breaths.

Diagnosis

Barrel chest is a visible symptom, so your doctor should be able to spot it on examination. They may also perform pulmonary function tests (e.g., spirometry) and bloodwork (e.g., a complete blood count and arterial blood gases) to assess how well your lungs are working.

Because barrel chest is not a disease in itself, so your doctor will work to identify the underlying condition causing it.

Treatment

The main goal of treatment is addressing the condition causing barrel chest to both manage symptoms and prevent further progression. While treatments will vary depending on the cause of barrel chest, reducing the inflammation leading to inefficient breathing is essential.

In the case of emphysema and osteoarthritis, the control of symptoms through diet and gentle exercise, medication, and pulmonary rehabilitation may lessen the appearance of a barrel chest, but these therapies cannot eliminate it entirely.

As COPD is a progressive disease, any damage sustained by the lungs, rib cage, or sternum cannot be reversed.

Cystic fibrosis also affects lung development, due in part to related recurrent bouts of bacterial infection. As lung capacity decreases, the development of barrel chest is enhanced and is unable to be reversed. This is especially true in adults with cystic fibrosis, who have an average lifespan of around 37 years.

Barrel chest in children with severe asthma will generally reverse once the symptoms are brought under control. The greater concern is that, if left untreated, severe asthma may lead to impaired growth.

A Word From Verywell

Barrel chest may be caused by several different factors, and it's ultimately a visual signal of something bigger. This sign usually appears in the later stages of certain conditions like emphysema and osteoarthritis and should be taken as a possible indication of severe lung damage. While the condition itself is not usually reversible, work with your healthcare team to find ways to manage your symptoms and hopefully make breathing a little bit easier.

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