Prevalence of pectus excavatum in an adult population-based cohort estimated from radiographic indices of chest wall shape (original) (raw)

The Comparison Of Measurements On Chest X-Ray For Patients With Pectus Deformity

The Internet Journal of Thoracic and Cardiovascular Surgery

Purpose: Various parameters have been proposed to measure of severity of pectus deformities. We performed some different measurements on the chest x-ray for the patients who underwent an operation for pectus deformity to determine a reasonable parameter for preoperative and postoperative assessment. Methods: A hundred patients, who don't have scoliosis and kyphosis, were selected for this study. Fifty of these patients had a pectus excavatum and remaining 50 had a pectus carinatum deformity. The measurements on poster-anterior (PA) and lateral (L) chest X-rays were performed preoperatively and postoperatively and compared statistically. Results: Only the parameters, which are measured on, lateral chest x-ray for patients in both groups are statistically meaningful. Conclusions: The three parameters (lateral dimension of cardiac silhouette, sternovertebral distance, the lateral transverse dimension of chest), which are measured on lateral chest x-ray, can be used for preoperative and postoperative assessment of both groups of patients.

Variation of the Anthropometric Index for pectus excavatum relative to age, race, and sex

Clinics (São Paulo, Brazil), 2013

To determine possible variations in the Anthropometric Index for pectus excavatum relative to age, race, and sex in individuals free of thoracic wall deformities. Between 2002 and 2012, 166 individuals with morphologically normal thoracic walls consented to have their chests and the perimeter of the lower third of the thorax measured according to the Anthropometric Index for pectus excavatum. The participant characteristics are presented (114 men and 52 women; 118 Caucasians and 48 people of African descent). Measurements of the Anthropometric Index for pectus excavatum were statistically significantly different between men and women (11-40 years old); however, no significant difference was found between Caucasians and people of African descent. For men, the index measurements were not significantly different across all of the age groups. For women, the index measurements were significantly lower for individuals aged 3 to 10 years old than for individuals aged 11 to 20 years old and...

Pectus excavatum imaging: enough but not too much

Pediatric Radiology, 2010

Background Pectus excavatum (pectus) is a common congenital deformity of the chest wall resulting in a diminished anterior-posterior dimension. Chest CT has become a common study for preoperative assessment. CT evaluation was initially described using a single CT image; it is now common to perform a CT of the entire chest to evaluate pectus. Objective To evaluate the efficacy of chest radiographs compared to chest CT in identifying additional clinically significant abnormalities in the preoperative evaluation of children with pectus. Materials and methods We reviewed the chest CT scans of 209 children and young adults who had been evaluated for possible surgical repair of pectus. Additional abnormalities were categorized as (1) incidental, (2) potentially significant, and (3) findings that affected the decision to perform surgery. Chest radiographs were reviewed for category 3 findings. Results Seventy-six scans showed additional abnormalities, five in group 2 and two in group 3. Both group 3 findings, a vascular ring and an acute pneumonia, were identified on chest radiographs. Conclusion Conventional radiographs identified clinically important findings in children and young adults evaluated for pectus surgery. Radiation risks and medical costs might be substantially decreased by obtaining a chest radiograph and using a limited CT technique when a CT scan is ordered for the purpose of obtaining a Haller index.

Pectus excavatum in adolescents and children: the Nuss technique

Pediatric Medicine, 2019

Pectus excavatum (PE) is also known as funnel or sunken chest. PE is the most common type of chest wall malformation, indeed occurs in about 1 of 300-400 births with a male predominance (M:F =3:1). It is featured of a depression of the body of the sternum and in association abnormalities of the costal cartilages. The aspect of the defect variant from mild to very severe. PE is frequently asymptomatic during childhood, but symptoms like easy tiredness and decreased hardiness often appear when patients become teenager or are involved in competitive sports. Surgical correction for PE has become rifer thanks to development of the mini-invasive repair (MIRPE), described for the first time by Nuss in 1989. MIRPE consists in a thoracoscopic fixing of at least one metal bar, which is maintained in the chest at least 2 years.

Pectus Excavatum: Consensus and Controversies in Clinical Practice

The Annals of Thoracic Surgery, 2023

BACKGROUND Pectus excavatum is the most common congenital anterior chest wall deformity. Currently, a wide variety of diagnostic protocols and criteria for corrective surgery are being used. Their use is predominantly based on local preferences and experience. To date, no guideline is available, introducing heterogeneity of care as observed in current daily practice. The aim of this study was to evaluate consensus and controversies regarding the diagnostic protocol, indications for surgical correction, and postoperative evaluation of pectus excavatum. METHODS The study consisted of 3 consecutive survey rounds evaluating agreement on different statements regarding pectus excavatum care. Consensus was achieved if at least 70% of participants provided a concurring opinion. RESULTS All 3 rounds were completed by 57 participants (18% response rate). Consensus was achieved on 18 of 62 statements (29%). Regarding the diagnostic protocol, participants agreed to routinely include conventional photography. In the presence of cardiac impairment, electrocardiography and echocardiography were indicated. Upon suspicion of pulmonary impairment, spirometry was recommended. In addition, consensus was reached on the indications for corrective surgery, including symptomatic pectus excavatum and progression. Participants moreover agreed that a plain chest radiograph must be acquired directly after surgery, whereas conventional photography and physical examination should both be part of routine postoperative follow-up. CONCLUSIONS Through a multiround survey, international consensus was formed on multiple topics to aid standardization of pectus excavatum care.

Outcome of surgical repair of Pectus Excavatum in adults

Journal of Cardiothoracic Surgery, 2017

Background: Pectus Excavatum (PEx) is the most common congenital chest wall deformity, accounting for over 90% of all chest wall deformities. Surgical correction is recommended because severe PEx can affect the physical and psychological development of patients. The aim of our study was to assess the impact of surgical repair of Pectus Excavatum in adults during hospital course and results after 1 year. Methods: Prospective study was carried out on 86 adult patients aged ≥ 15 years, 52 males and 34 females (mean age was 26 ± 1.5 years). All cases were divided into two groups, group I: (15-25 years old) and group II: (> 25 years old). Preoperative, operative, and postoperative data were reviewed. Statistical analysis was performed. Results: Statistical analyses revealed significant improvement postoperatively of cosmetic satisfaction (P-value < 0. 0001), pain (P-value =0.0003), exertional dyspnea (p-value <0.05) and exercise tolerance. The degree of chest compression was significantly improved after surgical correction within 12 months and the estimated measurement postoperatively of Haller Index showed significant reduction (p-value <0.001). Patient satisfaction postoperatively was excellent in 77.9% of all cases. Conclusion: Surgical correction of Pectus Excavatum using open technique in adults had excellent post-operative outcome in the short term follow up that encourage performing the procedure for all cases. Long term results need longer period for follow up. Etiology and predisposing factors still need further research.

Pectus excavatum from a pediatric surgeon’s perspective

Annals of Cardiothoracic Surgery, 2016

Historically, pectus excavatum (PE) was reported to be congenital, but in our experience only 22% are noticed in the first decade of life. Thus far, genetic studies support an autosomal recessive heritability, which coincides with only 40% of our patients having some positive family history, but is also contradictory given a constant sex ratio of 4:1 in favor of males. This inconsistency may be explained by the effect of more than one pectus disease-associated allele. Once the deformity is noticed, it tends to progress slowly until puberty, when rapid progression is often seen. We recommend surgical repair at around 12-14 years of age since the chest wall is still typically flexible and because this allows us to keep the bar in place as the patient progresses through puberty which may help decrease growth-related recurrences. Patients with mild to moderate PE are treated with therapeutic deep breathing, posturing, and aerobic exercises, and in appropriately selected patients, the vacuum bell may also be offered. Patients that have severe symptomatic PE are offered Minimally Invasive Repair of Pectus Excavatum (MIRPE). The surgical technique in children is similar to that of adults, except for the higher forces involved that often necessitate sternal elevation and more involved stabilization strategies. Postoperative management includes pain control, deep breathing, and early ambulation. Exercise restriction is mandatory for the first six weeks with slow resumption of normal activity after 12 weeks.