Chest Wall Deformities

Categories of Congenital Anterior Chest Wall Deformities

• 1. Pectus excavatum• 2. Pectus carinatum• 3. Poland’s syndrome• 4. Sternal defects • 5. Miscellaneous

Pectus excavatum

Pectus excavatum is posterior depression of the sternum and costal cartilage due to over grow of costal cartilage.

The 1st and 2nd ribs, manubrium are in normal position.

Asymmetrical of the depression may be present and the right is often more depressed than the left.

Pectus excavatum is present at birth or within the 1st year of life in most patients.

It may worsen at adolescent.

It may be associated with scoliosis, asthma.

Associated with….

• Scoliosis• Kyphosis• Myopathy• Marfan’s syndrome• Cerebral palsy• Tuberous sclerosis

It is well tolerated in infants and children.

Older child may have precordial pain after exercise

Palpitation may be present due to atrial arrythmia.

Systolic murmur results from close proximity of the sternum and the pulmonary artery.

ECG abnormality results from displacement of and rotation of the heart into the left thoracic cavity.

The maximum voluntary ventilation is lower than normal.

Some studies shows deterioration in pulmonary function after surgery due to increased rigidity of chest wall.

Exercise tolerance is improved after surgery

Pectus Carinatum

( Pigeon Chest )

It refers anterior protrusion of the sternum.

It is less common than pectus excavatum.

Types

Chondrogladiolar

(1) It is most common pectus

carinatum .

(2) It consists of anterior protrusion of the

body of sternum and lower costal

cartilages.

Mixed with excavatum and carinatum

It consists carinatum on one side and

excavatum on another side.

Chondromanubrial

(1) It is the most uncommon pectus carinatum.

(2) It consists protrusion of manubrium,

2nd and 3rd costal cartilages with

relative depression of the body and

sternum.

The etiology is unknown and genetic basis is favored.

It is more common in boys than girls.

It may be associated with M-S abnormality and congenital heart disease.

Polands syndrome

It refers congenital absence of the pectoralis major and minor muscles, ribs, breast abnormality, chest wall depression and syndactyly( or brachydactyly, ectromelia ).

It is present in 1/30000.

The etiology is unknown.

Often associated with VSD and other congenital heart disease..

Spinal Defomity

Scoliosis &Kyphosis

Ankylosing spondylitis

Spinal Deformity

Coronal plane

Scoliosis

Sagittal plane

Lordosis

Kyphosis

Scoliosis

lateral bending of spine

often associated with kyphosis

congenital

acquired fibrosis, post lung volume reduction surgery

Kyphosis

forward bending of spine

Compromises lung function

Restrictive lung disease

Pulmonary hypertension

Ankylosing spondylitis

Fusion of the spine

Loss of normal flexibility

Inflammatory back pain

Common in boys

Restriction of forward and lateral movement of spine

Schoebers test

Sacroilliac joint imaging

Associated enthesitis

Pulmonary function testing