A normal chest has a Haller index of 2 or less. A Haller index between 2 and 3. Both moderate and severe deformities can be considered for corrective surgery 4. This patient had a Haller index of 3. The severity of this index, in the setting of PFTs consistent with restrictive pulmonary process, with an echocardiogram that reveals right ventricular impingement, in a patient with shortness of breath and decreased exercise tolerance—all combine to provide a strong case for corrective surgery.
Chuang et al. However, a more recent study by Chu et al. Two corrective surgeries are available for pectus excavatum. The highly modified Ravitch technique involves a vertical incision in the midchest with resection of anterior cartilage, and placement of two stainless steel struts to support the sternum. The struts are wired to the ribs on both sides and removed after two years. The Nuss procedure, typically used on adolescent patients, uses two small incisions on either side of the chest to guide a curved steel bar Lorenz pectus bar into place.
The bar pushes out the sternum from within and is fixed to the ribs on each side; it stays in place for at least two years. Complications from surgical repair could include pneumothorax, bleeding, pleural effusion, infection, displacement of hardware, and recurrence of pectus excavatum 7.
The PA findings in this case are characteristic of pectus excavatum; the heart is displaced to the left and there is an opacity where the right heart border would normally be found Fig.
This opacity is caused by the compression of soft tissues of the anterior chest wall, as well as the more vertical orientation of the anterior ribs where they articulate with the sternum 3.
Thus it appears that the right heart border has been obscured by an opacity, which is the classic appearance of right-middle-lobe atelectasis or pneumonia. Actually, the right heart border has been displaced to the left, and the opacity is neither pneumonia nor atelectasis.
Radiologists must be prepared for this appearance, and correlate findings with lateral images, to avoid mistakenly diagnosing right-middle-lobe pneumonias. The radiologist, an important part of the evaluation of pectus excavatum, should be able to recommend any appropriate followup, including possible CT of the chest, and accurately measure a Haller index.
National Center for Biotechnology Information , U. Journal List Radiol Case Rep v. Radiol Case Rep. Published online Nov 6. Langan P. Struts can be removed but are intended to remain in place indefinitely. It involves making two small cuts on either side of the chest, slightly below the level of the nipples.
A third small incision allows surgeons to insert a miniature camera, which is used to guide the insertion of a gently curved metal bar. This forces the sternum outward. A second bar may be attached perpendicular to the first to help keep the curved bar in place. Stiches are used to close the incisions, and temporary drains are placed at or near the incision sites. This technique requires no cutting or removal of cartilage or bone. The metal bars are typically removed during an outpatient procedure about 2 years after the initial surgery in young people.
By then, correction is expected to be permanent. The bars may not be removed for 3 to 5 years or may be left in place permanently in adults. Surgical correction has an excellent success rate. However, any surgical procedure involves risk, including:. The most severe and uncommon risk with a Nuss procedure is direct injury to the heart.
Scars are unavoidable but are fairly minimal with the Nuss procedure. To reduce this risk, surgery is usually delayed until after age 8.
Complications are uncommon with either surgery, but the severity and frequency of complications in children and adults are about the same for types. According to a analysis of studies published in the journal Annals of Cardiothoracic Surgery that focused on both procedures in children and adults, the researchers found there are slightly fewer complications resulting from the Ravitch procedure in adults.
Gynecomastia is a medical condition that causes breast development in males. Some males may choose to have surgery to lessen the breast-like appearance of their chest. Both gynecomastia and sunken chest may become more noticeable during puberty.
Following surgery, a person can talk to their doctor about whether they need treatment for sunken chest. If the condition causes symptoms, your doctor may recommend surgical correction. Surgery to repair a sunken chest typically offers very positive results. Your doctor can evaluate the severity of your condition and help you decide whether surgery is right for you.
Pectus excavatum causes the chest to appear sunken. While exercise might seem daunting, it can both relieve symptoms and improve appearance. Do you have an uneven chest? Find out why and what to do about it. An uneven chest can be the result of relatively uncomplicated causes that are…. During exercise, a person diagnosed with pectus excavatum compensates by engaging the diaphragm in breathing in order to enable the lungs to expand more and obtain adequate oxygen and carbon dioxide exchange for the demands of the body.
The additional energy utilized for breathing in this manner contributes to fatigue. Those with severe pectus excavatum often notice that they are incapable of similar levels of activity as their peers.
This can be especially difficult for adolescents, who often withdraw from participating in sports or other high-stress physical activities. In addition to its more serious symptoms, pectus excavatum may have negative psychosocial effects in children and teenagers, who often experience self-consciousness and difficult peer interactions stemming from their appearance.
Often activities that expose the chest are avoided. Pectus Excavatum Surgical Repair. The ideal age for surgical treatment of pectus excavatum is between 12 and 18 years. The goal of surgery to correct a pectus excavatum defect is to improve breathing, posture, and cardiac function, in addition to giving the chest a normal appearance. This is typically accomplished by repositioning the breastbone. Surgical repair has excellent success rates and oftentimes, cardiovascular and lung function returns to near normal in the majority of cases.
This compression can also squeeze the heart, pushing it into the left side of the chest and reducing its ability to pump efficiently. This can cause symptoms such as exercise intolerance, shortness of breath, rapid heart rate and chest pain. Many people who have pectus excavatum will also tend to have a hunched-forward posture, with flared ribs and shoulder blades.
Many are so self-conscious about their appearance that they avoid activities, such as swimming, that make the indentation in their chests more difficult to camouflage behind clothing.
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Pectus excavatum Pectus excavatum is a condition in which a person's breastbone is sunken into his or her chest. Request an Appointment at Mayo Clinic.
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