Chest Wall Diseases

While chest pain is often thought to be a symptom associated to heart disease, it is also one of the most common symptoms related to chest wall diseases. Besides seeing patients for cardiac pain, the Department of Cardiothoracic Surgery at the National Heart Centre Singapore (NHCS) sees patients for chest wall diseases, a group of conditions affecting the rib cage and overlying muscles.

The chest wall includes the rib cage as well as the muscles protecting the underlying lung and heart. It can be affected by a variety of diseases including arthritis, infections or tumours. For tumours, they can be treated with surgical resection for long term cure. Reconstruction of the chest wall is also important to regain the shape of the chest both in terms of cosmesis and chest wall function.

Pectus excavatum (PE) or pectus carinatum (PC) are two conditions which led to deformity of the chest wall. PE results in a deep cavity at the front of the chest while PC results in a protrusion instead, also called ‘pigeon chest’. These deformities can result in decreased heart or lung function. Although more common in children, some may develop negative self-esteem from the deformity as they approach their teens. Repair of the deformities may be done minimally invasively or by an open method at NHCS.

​The symptoms of chest wall diseases are related to underlying conditions, such as arthritis, infections or tumours. This may also result in:

• Bony pains
• Shortness of breath
• Chest swelling
  
  

In some cases, the pain can be excruciating and can affect daily activities. While symptoms of chest wall diseases and the pain from heart attack may be similar, patients experiencing chest wall diseases tend to have localised pain in the joints of their chest.

​Costochondritis or arthritis of the chest wall joints can be related to wear and tear, it can also worsen after injury or physical strain to the chest area. Due to lack of conditioning, muscle strains involving the chest wall can also result in similar symptoms.

Chest wall disease can be more easily diagnosed through an examination of the chest. However, the doctor may order some diagnostic tests to evaluate the extent of the condition of the patient.

Examples of initial diagnostic tests are:

• Chest X-ray
• Echocardiogram
  
  

For mild cases of chest wall diseases, lifestyle changes and proper conditioning like physiotherapy will help. For severe cases, surgery is an option.

The treatment or repair of the chest wall deformities may be done surgically, through a minimally invasively surgery or by an open surgery method at the National Heart Centre Singapore (NHCS).

​Please follow the below instructions to prepare for chest wall diseases:

• Inform your doctor of your current medications as some medicines are unsuitable for consumption before a surgery.
• If you are a smoker, please refrain from smoking during this time period.
• Provide your clinician with a list of your medical history, particularly for allergies.
• You may need to undergo other medical examinations prior to the surgery. Some examples of the tests include:
  
  
• ECG (electrocardiogram)
• Blood tests
• Chest X-ray
• Urine sample
  
  

Patients who have undergone a surgery for chest wall diseases may be warded for a few days or as long as they are needed for observation. An electrocardiogram (ECG) monitor will continuously record the rhythm of the heart. Physical therapy will slowly be introduced, to strengthen the patient with light physical activities.

Patients who have duly rested and have stable conditions will be arranged for discharge. Follow-up appointments for regular check-ups will also be arranged at NHCS.

​​Related Health Articles:

• Early diagnosis and treatment for Chest Wall Diseases and Slipping Rib Syndrome (Lianhe Zaobao)
  
• ‘Rock’ he felt at ribcage was ‘slipping rib syndrome’; chest pain lasted a year before diagnosis (TODAY Online)