Presentation
Chest wall deformity.
Patient Data
Normal lungs. There is a horizontal orientation of the posterior ribs with downward slopping of anterior ribs. Note the right heart border is not indistinct in this case; however, there is a typical appearance of pectus excavatum on the lateral projection.
Post-operative x-ray after surgical correction of pectus excavatum showing Nuss bars in situ.
Case Discussion
On frontal x-ray films, indistinct right heart border, displacement of the heart on the left side, obliteration of the descending aorta interface, the horizontal appearance of the posterior ribs with downward sloping of the ribs anteriorly giving the reverse-7 sign suggests the diagnosis.
Pectus excavatum is surgically corrected by the Nuss procedure, which involves passing the Nuss bar(s) underneath the anterior chest wall. Common complications of this procedure include pneumothorax, hemothorax, pleural effusion, fracture, or migration of the Nuss bar.