Pectus excavatum

Case contributed by Vikas Shah
Diagnosis almost certain

Presentation

Shortness of breath after long distance travel, ?PE

Patient Data

Age: 20 years
Gender: Male

Chest x-ray

x-ray

The right heart border is indistinct. The lungs are otherwise clear. 

CT thorax

ct

There is no pulmonary embolism, and the lungs are clear. The heart is displaced towards the left by sternal depression due to pectus excavatum.

Case Discussion

The indistinct right heart border on the chest x-ray is accounted for the alteration of the chest wall in pectus excavatum. Another classic chest x-ray sign, not clearly seen here, is a horizontal orientation to the posterior ribs and downward sloping anterior ribs giving a 7 or reverse-7 sign.

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