Pectus excavatum: Difference between revisions
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Psychologically, untreated patients, especially youths, can experience negative [[psychosocial]] effects throughout their lives, avoiding activities where a shirt is not worn. |
Psychologically, untreated patients, especially youths, can experience negative [[psychosocial]] effects throughout their lives, avoiding activities where a shirt is not worn. |
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The condition usually progresses during the time of rapid bone growth in the early teenage years. Estimates for the prevalence of this condition range from one in 150 to 1000 children. Though the cause is not certain, the male/female ratio is 3 to 1, and occurrences of the condition in family members have been reported in 35% to 45% of cases.<ref name="emedicine">[http://www.emedicine.com/PED/topic2558.htm eMedicine - Pectus Excavatum : Article by Andre Hebra]</ref><ref name="ui">[http://www.uihealthcare.com/topics/medicaldepartments/surgery/pectusexcavatum/index.html Pectus Excavatum: Frequently Asked Questions: Surgery: UI Health Topics]</ref> |
The condition usually progresses during the time of rapid bone growth in the early teenage years. Estimates for the prevalence of this condition range from one in 150 to 1000 children. Though the cause is not certain, the male/female ratio is 3 to 1, and occurrences of the condition in family members have been reported in 35% to 45% of cases.<ref name="emedicine">[http://www.emedicine.com/PED/topic2558.htm eMedicine - Pectus Excavatum : Article by Andre Hebra]</ref><ref name="ui">[http://www.uihealthcare.com/topics/medicaldepartments/surgery/pectusexcavatum/index.html Pectus Excavatum: Frequently Asked Questions: Surgery: UI Health Topics]</ref> |
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Pectus excavatum is sometimes referred to as cobbler's chest, funnel chest, sunken chest, chest bowl, or simply a dent. |
Pectus excavatum is sometimes referred to as cobbler's chest, funnel chest, sunken chest, chest bowl, or simply a dent in the chest. |
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==Diagnosis== |
==Diagnosis== |
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Pectus excavatum is initially suspected from visual examination of the anterior chest, where the [[hallmark]] of the condition is a sunken |
It is currently unsure whether pectus excavatum is the result of genetic defect or whether the condition occurs in a sporadic fashion.<ref name=Crump1992/> Pectus excavatum is initially suspected from visual examination of the anterior chest, where the [[hallmark]] of the condition is a sunken appearance of the sternum.<ref name="emedicine"/> Auscultation of the chest typically reveals displaced heart sounds due to the movement (and rotation) of the heart.<ref name="emedicine"/> Mitral valve prolapse may also be revealed by this procedure when a clicking sound is present. Lung sounds are usually clear yet diminished due to decreased base lung volume.<ref name="emedicine"/> Pectus excavatum is a relatively common symptom of [[Marfan syndrome]] which may be diagnosed conjunctively with the appearance of pectus excavatum.<ref name="emedicine2">[http://www.emedicine.com/ped/topic1372.htm - Marfan Syndrome : Article by James Bowman]</ref> |
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==Treatment== |
==Treatment== |
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Revision as of 13:47, 15 April 2008
| Pectus excavatum | |
|---|---|
| Specialty | Genetics  |
Pectus excavatum (from the latin term meaning hollowed chest) is a congenital deformity of the sternum, which is pressed into the chest, resulting in a caved-in or sunken appearance of the chest. It is usually present at birth, but in some rare cases does not appear until the onset of puberty.
The deformity is sometimes considered to be a cosmetic rather than functional problem. However, recent studies have shown cases where pectus excavatum has impaired cardiac and respiratory function, and sometimes caused pain in the chest and back.[1] Psychologically, untreated patients, especially youths, can experience negative psychosocial effects throughout their lives, avoiding activities where a shirt is not worn.
The condition usually progresses during the time of rapid bone growth in the early teenage years. Estimates for the prevalence of this condition range from one in 150 to 1000 children. Though the cause is not certain, the male/female ratio is 3 to 1, and occurrences of the condition in family members have been reported in 35% to 45% of cases.[2][3]
Pectus excavatum is sometimes referred to as cobbler's chest, funnel chest, sunken chest, chest bowl, or simply a dent in the chest.
Diagnosis
It is currently unsure whether pectus excavatum is the result of genetic defect or whether the condition occurs in a sporadic fashion.[1] Pectus excavatum is initially suspected from visual examination of the anterior chest, where the hallmark of the condition is a sunken appearance of the sternum.[2] Auscultation of the chest typically reveals displaced heart sounds due to the movement (and rotation) of the heart.[2] Mitral valve prolapse may also be revealed by this procedure when a clicking sound is present. Lung sounds are usually clear yet diminished due to decreased base lung volume.[2] Pectus excavatum is a relatively common symptom of Marfan syndrome which may be diagnosed conjunctively with the appearance of pectus excavatum.[4]
Treatment
Before operation
Before operation several tests may be performed. These include but are not limited to; a CT scan, pulmonary function tests, and cardiology exams.[1] After a CT scan is taken the Haller index is measured. The patient's Haller is calculated by obtaining the measurement of inside left to inside right of the ribcage and dividing that by the distance from the sternum to the spine. A Haller Index of greater than 3.25 is generally considered severe, while normal chest has an index of 2.5.[5] [6] The cardiopulmonary tests are used to determine the lung capacity and to check for heart murmurs.
Surgery
Surgical correction has been shown to repair any functional symptoms that may occur in the condition, such as respiratory problems or heart murmurs, provided that permanent damage has not already arisen from an extremely severe case.[1]
Ravitch technique
The Ravitch technique is an invasive surgery that was developed in the 1950s to treat the condition. This procedure involves creating an incision along the chest through which the cartilage is removed and the sternum detached. A small bar is then inserted underneath the sternum to hold it up in the desired position. The bar is left implanted until the cartilage grows back, typically about 6 months. The bar is subsequently removed in a simple out-patient procedure. The Ravitch technique is not widely practiced because it is so invasive. It is often used in older patients, where the sternum has calcified, when the deformity is asymmetrical, or when the less invasive Nuss procedure has proven unsuccessful.
Nuss procedure
Since then, Dr. Donald Nuss, based at Children's Hospital of The King's Daughters (CHKD) in Norfolk, Virginia, has developed a technique that is minimally invasive. The Nuss procedure involves slipping in one or more concave steel bars into the chest, underneath the sternum. The bar is flipped to a convex position so as to push outward on the sternum, correcting the deformity. The bar usually stays in the body for about two years, although many surgeons are now moving toward leaving them in for up to five years. When the bones have solidified into place, the bar is removed through outpatient surgery.
Vacuum Bell
A relatively new alternative to surgery is the vacuum bell. It consists of a bowl shaped device which fits over the caved-in area; the air is then removed by the use of a hand pump. The vacuum created by this lifts the sternum upwards, lessening the severity of the deformity. As it is such a recent device there is currently no information as to whether it is effective in the long term.
Cosmetic and light treatments
The cosmetic appearance of Pectus excavatum can reportedly be treated with a dermal filler called Bio-Alcamid. However, as this does nothing to alleviate the actual deformity it will not prevent any physiological symptoms caused by the condition.
Mild cases have also reportedly been treated with corset-like orthopedic support vests and exercise.[7]
See also
- Pectus carinatum - another anatomical variation of chest shape, characterized by a protrusion of the sternum.
- Nuss procedure - a surgical procecure to elevate the sternum
- Haller index - a mathematical formula using a CT scan to measure the severity of Pectus Excavatum
References
- ^ a b c d Crump HW (1992). "Pectus excavatum". Am Fam Physician. 46 (1): 173–9. PMID 1621629.
- ^ a b c d eMedicine - Pectus Excavatum : Article by Andre Hebra
- ^ Pectus Excavatum: Frequently Asked Questions: Surgery: UI Health Topics
- ^ - Marfan Syndrome : Article by James Bowman
- ^ Haller Index page
- ^ Pectus Excavatum overview
- ^ Orthopectus - Dr. Sydney A. Haje, Ortopedista
External links
- CHKD: Nuss Procedure for Pectus Excavatum
- UK Pectus Excavatum and Pectus Carinatum Information
- Pectus Excavatum Information and Message Board
- Pectuscast: A podcast about pectus excavatum and the Nuss procedure
- Felix Schier, Michael Bahr, Eckard Klobe: The vacuum chest wall lifter: an innovative, nonsurgical addition to the management of pectus excavatumnext term
- A better incision for pectus excavatum repair: avoiding the keloid triangle