An Overview of Barrel Chest

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Barrel chest is 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.

A doctor observing a chest radiograph
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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 affect the anterior (forward-facing) chest wall and the posterior (back-facing) wall. As muscle wasting develops—which is often seen in later-stage emphysema—the loss of external support further promotes the deformity.

Barrel chest is not usually painful. It 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 narrowing of the airways and the excessive production of mucus.

Emphysema specifically refers to the destruction of the alveoli, the small air sacs in the lungs at the end of air passages through which oxygen is transferred to the blood and carbon dioxide is exhaled.

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.

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 lead to the gradual malformation of the spine.

Muscle loss can further weaken the external support, and the rib cage can develop a splayed, barrel-like appearance that can eventually become permanent if the joint bones fuse in this position.

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 young 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 persistently narrowed state of the air passages (in some cases, even after bronchodilators are used) can trap air in the lungs. As air becomes trapped in the lungs, 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.

  • Dyggve-Melchior-Clausen (DMC) syndrome is 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.

Diagnosis

Barrel chest is a visible effect of disease, so your doctor will be able to spot it with a physical examination.

You may also have 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, your doctor will work to identify the underlying condition causing it.

Treatment

The main goals of treatment are to manage symptoms and prevent further progression. Treatments will vary depending on the cause of barrel chest, but reducing inflammation and improving 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, barrel chest worsens and can't be reversed. This is especially true in adults with cystic fibrosis.

Barrel chest in children who have asthma will generally reverse once the symptoms are brought under control.

A Word From Verywell

Barrel chest is a clinical sign of several different medical conditions. It usually appears in the later stages of diseases like emphysema and should be taken as a possible indication of severe lung damage. While the condition itself is not usually reversible, it's important that you work with your healthcare team to find ways to manage your symptoms and make breathing a little bit easier.

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