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Clinical Summary

Pectus excavatum is a common developmental deformity of the anterior chest wall present in 0.25% of births. The cause is not well understood and may be related to intrauterine growth defects or muscle and connective tissue abnormalities within the thorax. In many cases, there is a family history of the condition.

The defect is a concavity of the anterior chest wall. Although the condition is occasionally associated with Marfan, scoliosis, and congenital heart disease, most patients are asymptomatic. In some, there is slightly decreased exercise tolerance, felt to be the effect of the consequence of the increased work of breathing caused by the chest wall mechanics.

Pectus carinatum is a chest wall deformity where the sternum protrudes forward and may involve the mid and lower sternum (chondrogladiolar prominence: 95%) or upper sternum (chondromanubrial prominence: 5%). It is an uncommon deformity and becomes evident in late childhood and worsens during adolescence. Most patients are asymptomatic, and repair is most often for cosmesis.

Management and Disposition

No definite treatment is needed, although cosmetic repairs of the anterior chest wall are sometimes recommended.

Pearls

  1. Congenital heart disease and Marfan syndrome are present in 1.5% of patients with pectus excavatum.

  2. Pectus excavatum may create a radiologic artifact that appears like a right middle lobe opacity.

FIGURE 7.83

Pectus Excavatum. A 26-year-old man presents to the emergency department with multisystem trauma after a motor vehicle crash. A longstanding pectus deformity is seen here. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 7.84

Pectus Carinatum. A 14-year-old boy with sore throat was found to have pectus carinatum deformity of the chondrogladiolar prominence type. He had no chest complaint. (Photo contributor: Lawrence B. Stack, MD.)

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