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

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and costal cartilage due to over grow of costal cartilage.

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

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Asymmetrical of the depression may be present and the

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right is often more depressed than the left.

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

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It may worsen at adolescent.

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It may be associated with scoliosis, asthma.

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•
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

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Palpitation may be present due to atrial arrythmia.

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

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ECG abnormality results from displacement of and rotation

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of the heart into the left thoracic cavity.

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•
The maximum voluntary ventilation is lower than normal.
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Some studies shows deterioration in pulmonary function

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after surgery due to increased rigidity of chest wall.

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Exercise tolerance is improved after surgery

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Pectus Carinatum
( Pigeon Chest )

It refers anterior protrusion of the sternum.

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It is less common than pectus excavatum.

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
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 carinatumon 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.
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It is more common in boys than girls.

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It may be associated with M-S abnormality and congenital

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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.
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The etiology is unknown.

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Often associated with VSD and other congenital heart

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disease..
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Spinal Defomity


 Scoliosis &Kyphosis
 Ankylosing spondylitis
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Spinal Deformity
Coronal plane

 Scoliosis
Sagittal plane

 Lordosis
 Kyphosis
Scoliosis


 lateral bending of spine

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 often associated with kyphosis

congenital

acquired fibrosis, post lung volume

reduction surgery
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Kyphosis
 forward bending of spine
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Compromises lung function

Restrictive lung disease

Pulmonary hypertension

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Ankylosing spondylitis
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Fusion of the spine

Loss of normal flexibility

Inflammatory back pain

Common in boys
Restriction of forward and lateral movement of spine
Schoebers test
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Sacroilliac joint imaging

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Associated enthesitis
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Pulmonary function testing

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