#Misshapen ribs series

Pectus excavatum is differentiated from other disorders by a series of elimination of signs and symptoms. Some studies also suggest that the Haller index can be calculated based on chest x-ray as opposed to CT scanning in individuals who have no limitation in their function. The chest x-ray in pectus excavatum can show an opacity in the right lung area that can be mistaken for an infiltrate (such as that seen with pneumonia). Pectus excavatum on PA chest radiograph with shift of heart shadow to the left and radioopacity of the right paracardiac lung fieldĬhest x-rays are also useful in the diagnosis. The Haller index is the ratio between the horizontal distance of the inside of the ribcage and the shortest distance between the vertebrae and sternum. An index over 3.25 is often defined as severe. More recently the Haller index has been used based on CT scan measurements. One such index is the Backer ratio which grades severity of deformity based on the ratio between the diameter of the vertebral body nearest to xiphosternal junction and the distance between the xiphosternal junction and the nearest vertebral body. Most of these are variants on the distance between the sternum and the spine. Many scales have been developed to determine the degree of deformity in the chest wall. Lung sounds are usually clear yet diminished due to decreased base lung capacity. There can be a heart murmur occurring during systole caused by proximity between the sternum and the pulmonary artery.

Auscultation of the chest can reveal displaced heart beat and valve prolapse. Pectus excavatum is initially suspected from visual examination of the anterior chest. Diagnosis Ĭross sectional scan of a chest with pectus excavatum However, a 2016 meta-analysis found significant evidence that surgical correction of pectus excavatum improves patient cardiac performance. While some studies have demonstrated decreased cardiovascular function, no consensus has been reached based on newer physiological tests such as echocardiography of the presence or degree of impairment in cardiovascular function. Because the heart is located behind the sternum, and because individuals with pectus excavatum have been shown to have visible deformities of the heart seen both on radiological imaging and after autopsies, it has been hypothesized that there is impairment of the function of the cardiovascular system in individuals with pectus excavatum. Physiologically, increased pressure in utero, rickets and increased traction on the sternum due to abnormalities of the diaphragm have been postulated as specific mechanisms. Many children with spinal muscular atrophy develop pectus excavatum due to their diaphragmatic breathing. Pectus excavatum can be present in other conditions too, including Noonan syndrome, Marfan syndrome and Loeys–Dietz syndrome as well as other connective tissue disorders such as Ehlers–Danlos syndrome. It was believed for decades that pectus excavatum is caused by an overgrowth of costal cartilage, however people with pectus excavatum actually tend to have shorter, not longer, costal cartilage relative to rib length. As of 2012, a number of genetic markers for pectus excavatum have also been discovered. A small sample size test found that in at least some cases, 37% of individuals have an affected first degree family member. Others assume that there is some genetic component. Some researchers take the stance that it is a congenital disorder (birth defect), but not genetic. Researchers are unsure of the cause of pectus excavatum. Psychological symptoms manifest with feelings of embarrassment, social anxiety, shame, limited capacity for activities and communication, negativity, intolerance, frustration, and even depression. In severe cases, the right atrium may be compressed, mitral valve prolapse may be present, and physical capability may be limited due to base lung capacity being decreased. In mild cases, cardiorespiratory function is normal, although the heart can be displaced and/or rotated. People may also experience chest and back pain, which is usually of musculoskeletal origin. Pectus excavatum defects may be symmetric or asymmetric. The lower-most ribs may protrude ('flared ribs'). The most common form is a cup-shaped concavity, involving the lower end of the sternum a broader concavity involving the upper costal cartilages is possible. The hallmark of the condition is a sunken appearance of the sternum. 5.2.4 Sternal zenithal traction system: Osasun Track.

Misshapen ribs