Thursday, January 19, 2017

Chest X Ray Showing Depressed Sternum (Pectus Excavatum)

A 48 years old male came to radiology department for X-ray chest with history of cough over several days. His chest X ray is shown below:

X-ray chest PA and lateral view show depressed sternum or pectus excavatum (arrow), otherwise lung fields are clear.

Discussion: Pectus excavatum or depressed sternum is a congenital condition in which the sternum is caved-in along with the ribs and on X-ray chest the heart may be a little more on right side because of rotation. It can be present at birth. It is also known as cobbler’s chest, sunken chest or funnel chest.
In this, the anterior ribs being more vertical and the posterior ribs being horizontal than normal.
Pectus excavatum is sometimes considered to be cosmetic; but may develop cardiac and respiratory symptoms. The heart may be displaced or rotated and base lung capacity may be decreased.

Clinical Point Of View: Pectus excavatum, also known as sunken or funnel chest is a congenital chest wall deformity in which several ribs and the sternum grow abnormally, producing a concave, or caved-in, appearance in the anterior chest wall.
It is a common type of congenital chest wall abnormality (90%), followed by pectus carinatum (5 7%), cleft sternum, pentalogy of Cantrell, asphyxiating thoracic dystrophy, and spondylothoracic dysplasia.
Pectus excavatum occurs in an estimated 1 in 400 births, with male predominance (male-to-female ratio of 3:1). The condition is typically noticed at birth, and more than 90% of cases are diagnosed within the first year of life.
Patients younger than 10 years do not typically experience symptoms associated with shortness of breath and tend to become symptomatic during their teenage years or in early adult life.
No effective nonoperative management strategies can correct of severe pectus excavatum.
The operative treatment of pectus excavatum had been fairly well standardized and is based on the open operation originally described by Ravitch in 1949. Surgery is indicated only if the patient develops cardiopulmonary impairment. The most common goal in operative repair of pectus excavatum is to correct the chest deformity. The desire to improve the appearance of the chest is also considered an appropriate medical indication for surgery, especially in young patients.

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