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Alexander Marmureanu
Alexander Marmureanu
Pectus Excavatum
Pectus excavatum is an abnormal development of the chest wall in which several ribs and the sternum grow abnormally, resulting in a caved-in, or sunken appearance. It is considered be a relatively common congenital deformity and occurs more often in males than in females. Approximately 40% of pectus excavatum patients have one or more family members with the defect.
Development and Causes of Pectus Excavatum
Often present at birth, the condition may also develop during puberty and can range from mild to severe. As the child matures, symptoms of easy fatigability and decreased stamina and endurance become apparent. Although its causes are not completely understood, the condition is believed to arise from excessive growth of the cartilage connecting the ribs to the breastbone leading to the pulling inward of the sternum.
Symptoms
Pectus excavatum can compromise lung and heart capacity, especially when it is severe, causing the patient to experience reduced exercise tolerance , fatigue, shortness of breath, chest pain, and a fast heartbeat. In some patients, there may be a heart murmur caused by the proximity of the sternum and the pulmonary artery. For ordinary everyday activities, a person with pectus excavatum may have no symptoms, however with rigorous exercise, symptoms often appear. Lung capacity may be curtailed because lungs are confined and cannot properly expand. During exercise, the patient 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. Patients 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 and teenagers, 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 child and teen-age patients, who experience self consciousness and difficult peer interactions stemming from their appearance. Often these children and teenagers avoid activities that expose the chest.
Diagnosis
In examining the patient, multiple tools are used to diagnose the condition and gauge
its extent. These include:
- Visual examination of the chest
- Ausculation—analysis of sounds
of the heart and chest to detect
the condition's effect on heart
and lung function - Electrocardiogram (ECG)
- Echocardiogram (a noninvasive
test that takes a picture of the
heart taken with sound waves) - Pulmonary function testing
(patient breathes into a
mouthpiece connected to an
instrument that measures the
amount of air breathed over a
period of time) - Chest X-ray
- CT-scan
- Obtaining the patient's Haller Index: A measure of extent of pectus excavatum, the Haller index is measured by means of the CT scan. It is calculated by obtaining the ratio of the horizontal distance of the inside of the ribcage and the shortest distance between the vertebrae and sternum. A Haller Index of greater than 3.25 is generally considered severe (a normal Haller Index is 2.5).
A CT scan of a 14 year old male with severe pectus excavatum
