Pectus excavatum

Case contributed by Eric Diaz

Presentation

The patient reports significant dyspnea and chest pain within a minute of any sprint activity and similar symptoms within 2-3 minutes with lite jogging.  He also reports tachycardia with this exercise. No symptoms at rest or regular walking activity. No syncope or near syncope. No daily cough or wheezing. He also mention that he was tired of his peers making fun of his chest.

Patient Data

Age: 16
Gender: Male
mri

Substantial pectus excavatum deformity is visualized. The right ventricle is deformed by the pectus deformity at the level of the base of the right ventricle and the tricuspid valve. The heart is displaced into the left hemithorax.

Haller index: 22.8 cm /2.1cm = 10.85
Depression index: 3.76 / 3.18 = 1.12
Correction index: (7.1cm - 2.1cm)/7.1cm = 70.4%.
Sternal torsion: 31 degrees left side down tilt.

x_ray

Correlative lateral projection demonstrating pectus excavatum. 

Case Discussion

While repair is not a medical necessity, the two primary indications for moving forward are cosmetic and to improve his perception of his body image, or to permit him to have a more active lifestyle in the future. 

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