Fact-sheet: Pectus excavatum
Updated on 10/06/2017 at 4:26 PM
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Definition
The most common (90%) of thoracic malformations; caused by excessive length of the anterior chondrosternal cartilages.
Clinical features
1/400 to 1/700 births, 4 M/1 F.
Etiologies – associated abnormalities:
.idiopathic (80%)
.scoliosis ++ (15 to 20% of cases)
.Marfan syndrome +++; must be systematically investigated
.cardiac malformations: mitral valve prolapse (20 to 60%)
Radiography
Frontal chest radiograph:
Right border of the spine abnormally visible, as it is "uncovered".
Right mediastinal border no longer visible.
Straightening of the left mediastinal border with alignment of the middle arch
CT
"Obvious" diagnosis, depression of the sternal region.
Leftward displacement of mediastinal structures.
Calculation of the Haller index to determine management
Management
- Surgery in severe forms or those with cardiac or respiratory impact (Nuss or Ravitch techniques)
- Psychological support
Classification
Morphological, Haller index:
transverse diameter/anteroposterior diameter;
if > 3:
severe form
Differential diagnosis
On the standard frontal radiograph:
- middle lobe atelectasis
- acute lobar pneumonia of the middle lobe
- right cardiophrenic angle mass
.hypertrophied fat pad
.pericardial cyst
.Morgagni hernia (Larrey's cleft)