Chest Wall Conditions
Slipped Rib Syndrome: Why It Is So Often Missed
Slipped rib syndrome is one of the most consistently under-diagnosed conditions in thoracic medicine. Many patients spend years being investigated for gastrointestinal, spinal, or musculoskeletal causes before the correct diagnosis is reached.
The condition arises from the lower ribs — the 8th, 9th, and 10th — which are joined by fibrocartilaginous tissue that can loosen, allowing adjacent ribs to overlap and catch. The resulting pain is typically felt in the lower chest, worsened by twisting, reaching overhead, or deep breathing.
The “hooking manoeuvre” establishes the diagnosis at the bedside. Where surgery is right, keyhole rib resection achieves pain relief in over 80% of patients. Unexplained chest pain page →
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Lung Cancer & Nodules
A Lung Nodule on Your CT Scan: What It Means and What Happens Next
The vast majority of lung nodules are benign. However, a proportion are early lung cancers, and the size, shape, and density provide important clues about likelihood of malignancy.
Robotic navigational bronchoscopy has transformed the diagnostic pathway — a robotic catheter uses a real-time 3D map to navigate to peripheral nodules, obtaining a tissue sample without surgical incision. ION bronchoscopy page →
Five-year survival for Stage I lung cancer treated surgically exceeds 80%. The earlier the surgery, the less lung tissue removed and the faster the recovery. Shadow on lung scan →
Full Information & the Nodule Pathway →
Diaphragm Conditions
Diaphragm Paralysis: A Frequently Missed Cause of Breathlessness
The diaphragm accounts for approximately 70% of the work of breathing at rest. When paralysed — often after cardiac surgery, trauma, or tumour — the resulting breathlessness can be severe and disabling.
A key feature is breathlessness markedly worse when lying flat, bending forward, or swimming — symptoms frequently attributed to other causes for months or years. Breathlessness page →
Diaphragmatic plication — keyhole tightening of the weakened diaphragm — restores mechanical function and improves breathlessness in the majority of patients.
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Hyperhidrosis
Hyperhidrosis: When Excessive Sweating Becomes a Surgical Problem
Primary hyperhidrosis affects an estimated 1–3% of the population. For many it is genuinely life-limiting — caused by overactivity of the sympathetic nervous system.
Endoscopic thoracic sympathectomy (ETS) is keyhole surgery that divides the relevant sympathetic chain through a single small incision on each side of the chest. Success rates above 95% for palmar sweating. Most patients stay 1–2 nights and relief is typically felt within days. Excessive sweating page →
Full discussion of risks and expected outcomes — including compensatory sweating — is always provided before any decision is made.
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Pleural Disease
Pleural Disease: Effusion, Infection, and Mesothelioma
The pleural space between the lung and chest wall can be affected by fluid accumulation (pleural effusion), infection (empyema), cancer (mesothelioma), and endometriosis. Each has a distinct cause and requires a different management approach.
A pleural effusion — fluid around the lung — causes breathlessness and requires accurate diagnosis of the underlying cause before drainage is planned. Empyema typically requires surgical drainage and washout. Mesothelioma requires specialist assessment.
Thoracic endometriosis affecting the pleura causes cyclical chest pain and may present as a catamenial pneumothorax — a collapsed lung recurring around the time of menstruation. Cyclical chest symptoms →
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Pneumothorax
Pneumothorax: When the Lung Collapses — and How to Prevent It Happening Again
A pneumothorax — commonly called a collapsed lung — occurs when air leaks between the lung and chest wall. It is most common in young, tall, slim men, but can occur in anyone, and has a recurrence rate of up to 50% without treatment.
Keyhole surgery to remove the source of the air leak and create a controlled adhesion between the lung and chest wall significantly reduces the risk of recurrence. For women, catamenial pneumothorax — collapse linked to the menstrual cycle — requires specialist investigation for thoracic endometriosis.
Dr Okiror is co-PI at GSTT for the NIHR-funded PRO-SEAL trial (ISRCTN15099654) — evaluating approaches to persistent air leak in secondary spontaneous pneumothorax.
Full Information & Consultation →