lung function study

[Guest guest]

Volume 8, Issue 4, Pages 639-644 (July 2008)

Lung function asymmetry in children with congenital and infantile

scoliosis

Redding, MDaCorresponding Author Informationemail address,

Kit Song, MDa, Steve Inscore, MDb, Effmann, MDa,

, MDb

Received 19 January 2007; accepted 25 April 2007. published online 08

October 2007.

Abstract

Background context

Progressive scoliosis alters lung function by reducing chest wall

compliance and excursion and rotating intrathoracic contents,

producing an increasingly asymmetric lung size. The effect of this

distortion on regional lung perfusion and ventilation has not been

described in children with congenital and infantile forms of

scoliosis. The severity of scoliosis is often described by the Cobb

angle of the spine, but the relationship between Cobb angle and lung

function asymmetry between concave and convex lungs has not been

described in this group of children.

Purpose

To describe the frequency of asymmetric lung perfusion and

ventilation among children with congenital or infantile thoracic

scoliosis before surgical treatment and the relationship between Cobb

angle and asymmetry of lung function.

Study design/setting

Prospective comparison of lung perfusion scans and spine film

findings in children evaluated in two pediatric spine referral

clinics for expansion thoracoplasty and vertical expandable

prosthetic titanium rib (VEPTR) implantation.

Patient sample

Thirty-nine children, aged 1 year 8 months to 15 years 6 months, with

congenital or infantile forms of scoliosis who are clinically stable

outpatients and have neither primary pulmonary disease nor

neuromuscular weakness.

Outcome measures

1) Cobb angle measurements from weightbearing spine films and 2)

right and left contributions to total lung perfusion and total lung

ventilation compared with normal values.

Methods

Lung perfusion scans using technetium-labeled albumin macroaggregates

were performed in all children; 15 of the children also underwent

ventilation lung scans using aerosolized technecium-labeled

diethylenetriaminepentaacetic acid (DTPA). The degree of asymmetry

between right and left lung function from the normal right-to-left

lung distribution was correlated with the Cobb angle of the spine.

Ventilation and perfusion asymmetry between right and left lungs was

also compared.

Results

Sixteen of the 25 children with congenital scoliosis had fused ribs;

13 additional children had infantile scoliosis. Cobb angles ranged

from 30° to 112° in the group (median=71°), with the concave lung

being the left lung in 61% of cases. Lung function relations between

the right and left lungs were abnormal (>5% deviation from the normal

55% right [R]/45% left [L]) in 21 (54%) patients. Right-left

contributions to lung perfusion ranged from 86% R/14% L to 26% R/74%

L among the 39 children. Lung function in the concave lung was

reduced below the normal proportion in only 20 children (51%). Lung

function asymmetry, measured as the deviation from the normal

contributions of the right and left lungs, did not correlate with

Cobb angle values (r=.14, p=.4). Ventilation asymmetry and perfusion

asymmetry were concordant and correlated closely (r=.93, p<.0001).

Conclusions

Asymmetric ventilation and perfusion between the right and left lungs

occurs in more than half of the children with severe congenital and

infantile thoracic scoliosis. However, the severity of lung function

asymmetry does not relate to Cobb angle measurements. Asymmetry in

lung function is influenced by deformity of the chest wall in

multiple dimensions, and cannot be ascertained by chest radiographs

alone.

Keywords: Congenital scoliosis, Infantile scoliosis, Lung function,

Lung perfusion, Children, Cobb angle

a University of Washington School of Medicine, Seattle, WA, USA

b University of Texas Health Science Center at San , 7703

Floyd Curl Drive, San , TX, USA 78284

Corresponding Author InformationCorresponding author. Children's

Hospital and Regional Medical Center, Pulmonary Division, Mail stop A-

5937, 4800 Sand Point Way N.E., Seattle, WA 98105, USA. Tel.: (206)

987-2174; fax: .

This work was supported by a grant from Synthes Corporation.

PII: S1529-9430(07)00205-7

doi:10.1016/j.spinee.2007.04.020

© 2008 Elsevier Inc. All rights reserved.

[Guest guest]

Thanks for the article ! I think Moriah might have been one of those numbers. She had this scan in 2005. The only one Texas ever did for her.

shellie

Subject: lung function studyTo: infantile_scoliosis Date: Thursday, July 3, 2008, 11:55 AM

Volume 8, Issue 4, Pages 639-644 (July 2008)Lung function asymmetry in children with congenital and infantile scoliosis Redding, MDaCorresponding Author Informationemail address, Kit Song, MDa, Steve Inscore, MDb, Effmann, MDa, , MDbReceived 19 January 2007; accepted 25 April 2007. published online 08 October 2007.Abstract Background contextProgressive scoliosis alters lung function by reducing chest wall compliance and excursion and rotating intrathoracic contents, producing an increasingly asymmetric lung size. The effect of this distortion on regional lung perfusion and ventilation has not been described in children with congenital and infantile forms of scoliosis. The severity of scoliosis is often described by the Cobb angle of the spine, but the relationship between Cobb angle and lung function asymmetry between concave and convex

lungs has not been described in this group of children.PurposeTo describe the frequency of asymmetric lung perfusion and ventilation among children with congenital or infantile thoracic scoliosis before surgical treatment and the relationship between Cobb angle and asymmetry of lung function.Study design/settingProspective comparison of lung perfusion scans and spine film findings in children evaluated in two pediatric spine referral clinics for expansion thoracoplasty and vertical expandable prosthetic titanium rib (VEPTR) implantation.Patient sampleThirty-nine children, aged 1 year 8 months to 15 years 6 months, with congenital or infantile forms of scoliosis who are clinically stable outpatients and have neither primary pulmonary disease nor neuromuscular weakness.Outcome measures1) Cobb angle measurements from weightbearing spine films and 2) right and left

contributions to total lung perfusion and total lung ventilation compared with normal values.MethodsLung perfusion scans using technetium-labeled albumin macroaggregates were performed in all children; 15 of the children also underwent ventilation lung scans using aerosolized technecium-labeled diethylenetriaminep entaacetic acid (DTPA). The degree of asymmetry between right and left lung function from the normal right-to-left lung distribution was correlated with the Cobb angle of the spine. Ventilation and perfusion asymmetry between right and left lungs was also compared.ResultsSixteen of the 25 children with congenital scoliosis had fused ribs; 13 additional children had infantile scoliosis. Cobb angles ranged from 30° to 112° in the group (median=71°), with the concave lung being the left lung in 61% of cases. Lung function relations between the right and left lungs were

abnormal (>5% deviation from the normal 55% right [R]/45% left [L]) in 21 (54%) patients. Right-left contributions to lung perfusion ranged from 86% R/14% L to 26% R/74% L among the 39 children. Lung function in the concave lung was reduced below the normal proportion in only 20 children (51%). Lung function asymmetry, measured as the deviation from the normal contributions of the right and left lungs, did not correlate with Cobb angle values (r=.14, p=.4). Ventilation asymmetry and perfusion asymmetry were concordant and correlated closely (r=.93, p<.0001).ConclusionsAsymmetric ventilation and perfusion between the right and left lungs occurs in more than half of the children with severe congenital and infantile thoracic scoliosis. However, the severity of lung function asymmetry does not relate to Cobb angle measurements. Asymmetry in lung function is influenced by deformity of the

chest wall in multiple dimensions, and cannot be ascertained by chest radiographs alone.Keywords: Congenital scoliosis, Infantile scoliosis, Lung function, Lung perfusion, Children, Cobb anglea University of Washington School of Medicine, Seattle, WA, USAb University of Texas Health Science Center at San , 7703 Floyd Curl Drive, San , TX, USA 78284Corresponding Author InformationCorrespo nding author. Children's Hospital and Regional Medical Center, Pulmonary Division, Mail stop A-5937, 4800 Sand Point Way N.E., Seattle, WA 98105, USA. Tel.: ; fax: .This work was supported by a grant from Synthes Corporation.PII: S1529-9430(07) 00205-7doi:10.1016/ j.spinee. 2007.04.020© 2008 Elsevier Inc. All rights reserved.