Materiały źródłowe

• #1 Current Management of Pectus Excavatum: A Review and Update of Therapy and Treatment Recommendations | American Board of Family Medicine

  https://www.jabfm.org/content/23/2/230

  Pectus excavatum (PE) is a posterior depression of the sternum and adjacent costal cartilages and is frequently seen by primary care providers. PE accounts for 90% of congenital chest wall deformities. Patients with PE are often dismissed by physicians as having an inconsequential problem; however, it can be more than a cosmetic deformity. Severe cases can cause cardiopulmonary impairment and physiologic limitations. Evidence continues to present that these physiologic impairments may worsen as the patient ages. Data reports improved cardiopulmonary function after repair and marked improvement in psychosocial function. […] The presentation of a patient with PE warrants a thorough workup to access the significance of the defect. This workup does not necessarily include every possible physiologic test, but can include those necessary to determine whether the patient should be referred to a surgeon for a discussion of repair options.

• #2 Pectus Excavatum: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1004953-overview

  Pectus excavatum occurs in an estimated 1 in 300-400 births, with male predominance (male-to-female ratio of 3:1). The condition is typically noticed at birth, and more than 90% of cases are diagnosed within the first year of life. […] Most cases of severe pectus excavatum are noticed at birth, with progressive worsening of the child’s growth and development. More than 80% of all cases are identified within the first 1-2 years of life. The condition typically becomes much more pronounced at puberty, during the time of rapid bone and cartilage growth. Most patients are brought to medical attention during their teenage years because of the significant change in the appearance of their chest. […] The prognosis of pectus excavatum, with treatment, is excellent. Patients with mild pectus excavatum who do not undergo operative correction also have an excellent prognosis. Patients with moderate-to-severe pectus excavatum may experience problems related to cardiopulmonary impairment, decreased exercise tolerance, decreased stamina, and adjustment disorders related to the impact of this deformity on body image and coping mechanisms.

• #3 Current management of pectus excavatum: a review and update of therapy and treatment recommendations – PubMed

  https://pubmed.ncbi.nlm.nih.gov/20207934/

  Pectus excavatum (PE) is a posterior depression of the sternum and adjacent costal cartilages and is frequently seen by primary care providers. PE accounts for 90% of congenital chest wall deformities. Patients with PE are often dismissed by physicians as having an inconsequential problem; however, it can be more than a cosmetic deformity. Severe cases can cause cardiopulmonary impairment and physiologic limitations. Evidence continues to present that these physiologic impairments may worsen as the patient ages. Data reports improved cardiopulmonary function after repair and marked improvement in psychosocial function. More recent consensus by both the pediatric and thoracic surgical communities validates surgical repair of the significant PE and contradicts arguments that repair is primarily cosmetic. […] We performed a review of the current literature and treatment recommendations for patients with PE deformities.

• #4 Pectus Excavatum: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17328-pectus-excavatum

  Pectus excavatum is a congenital condition, which means you’re born with it. […] Healthcare providers can correct pectus excavatum with minimally invasive surgery or traditional open surgery. […] A healthcare provider can diagnose pectus excavatum with a simple physical examination. Providers may not notice the issue until you’re in your early teens. They may want to do testing to see how much pectus excavatum is affecting your cardiopulmonary (heart and lung) function. […] Tests for pectus excavatum may include: Magnetic resonance imaging (MRI) of your chest, Computed tomography (CT) of your chest, Cardiopulmonary (heart and lungs) exercise testing, Electrocardiogram (EKG), Echocardiogram, Pulmonary function tests (PFTs). […] A surgeon can correct pectus excavatum with a minimally invasive (Nuss procedure) or an open (Ravitch procedure) operation. Your surgeon will discuss which procedure is best for you.

• #5 Pectus Excavatum | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/pectus-excavatum

  Pectus excavatum is usually diagnosed during a physical examination. X-rays of the chest can help your child’s doctor confirm the diagnosis. […] At Boston Children’s Hospital, we also use a white light scanner — a type of three-dimensional (3D) camera — to help measure your child’s chest wall depression and monitor their response to treatment over time. […] Other recommended tests might include: Echocardiogram (also known as cardiac ultrasound), Pulmonary function test (PFT), Cardiopulmonary exercise test (CPET).

• #6 Pectus excavatum – Wikipedia

  https://en.wikipedia.org/wiki/Pectus_excavatum

  Pectus excavatum is initially suspected from visual examination of the anterior chest. Auscultation of the chest can reveal displaced heart beat and valve prolapse. There can be a heart murmur occurring during systole caused by proximity between the sternum and the pulmonary artery. Lung sounds are usually clear yet diminished due to decreased base lung capacity. […] Many scales have been developed to determine the degree of deformity in the chest wall. Most of these are variants on the distance between the sternum and the spine. 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. More recently the Haller index has been used based on CT scan measurements. An index over 3.25 is often defined as severe.

• #7 Pectus Excavatum: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1004953-overview

  Pectus excavatum occurs in an estimated 1 in 300-400 births, with male predominance (male-to-female ratio of 3:1). The condition is typically noticed at birth, and more than 90% of cases are diagnosed within the first year of life. […] Most cases of severe pectus excavatum are noticed at birth, with progressive worsening of the child’s growth and development. More than 80% of all cases are identified within the first 1-2 years of life. The condition typically becomes much more pronounced at puberty, during the time of rapid bone and cartilage growth. Most patients are brought to medical attention during their teenage years because of the significant change in the appearance of their chest. […] The prognosis of pectus excavatum, with treatment, is excellent. Patients with mild pectus excavatum who do not undergo operative correction also have an excellent prognosis. Patients with moderate-to-severe pectus excavatum may experience problems related to cardiopulmonary impairment, decreased exercise tolerance, decreased stamina, and adjustment disorders related to the impact of this deformity on body image and coping mechanisms.

• #8 Pectus Excavatum Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/1004953-workup

  No specific laboratory study is necessary in the workup of patients with pectus excavatum. Most children with this condition are otherwise healthy. […] Imaging studies are important in the initial assessment of any patient with pectus excavatum. […] Some surgeons obtain a baseline 2-view chest radiography (anteroposterior and lateral views) in all patients. This provides information about any possible associated intrathoracic pathology, severity of the lung compression, and mediastinal displacement. […] However, it does not provide any information about the appearance of the affected ribs because the cartilaginous part is the involved part and is not visible on standard radiographs. […] In addition, plain chest radiography allows for assessment of the spine and possible associated scoliosis, a common finding in many patients with pectus excavatum.

• #9 Pectus excavatum – Wikipedia

  https://en.wikipedia.org/wiki/Pectus_excavatum

  Chest x-rays are also useful in the diagnosis. 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). 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. […] Pectus excavatum is differentiated from other disorders by a series of elimination of signs and symptoms. Pectus carinatum is excluded by the simple observation of a collapsing of the sternum rather than a protrusion. Kyphoscoliosis is excluded by diagnostic imaging of the spine, wherein pectus excavatum the spine usually appears normal in structure.

• #10 Pectus Excavatum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430918/

  Approximately 95 percent of congenital chest wall anomalies are attributed to pectus deformities, with pectus excavatum being the most common. […] This activity examines the differential of pectus excavatum and how to properly evaluate a patient with pectus excavatum, and highlights the role of the interprofessional team in caring for patients with this condition. […] Describe a complete evaluation of pectus excavatum, including any appropriate diagnostic imaging. […] The lateral view of the chest radiograph clearly demonstrates the sternal defect. Additional imaging studies may reveal displaced vertebral bodies and varying degrees of scoliosis. […] Complete evaluation includes chest radiograph, pulmonary function testing (spirometry, plethysmography, respiratory muscle strength assessment), electrocardiogram, and echocardiogram to assess for the secondary or associated anomalies of a clinical syndrome.

• #11 Pectus Excavatum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430918/

  The Haller index (HI) is the standard upon which to quantify the severity of a pectus excavatum deformity. […] Surgical (pediatric or cardiothoracic) consultation should be sought for all patients with a Haller Index of 2.5 or greater, as well as for patients with concomitant cardiac defects that need surgical repair or decreased pulmonary reserve. […] Regardless of the Haller index measure, impaired cardiopulmonary function is an indication for surgical correction. […] Surgical correction of the funnel chest attributed to a pectus excavatum defect significant improves pulmonary function at rest and VO2 max in cases in which the Hallex index measures greater than 3.2.

• #12 Pectus Excavatum Symptoms, Causes, and Treatment | Liv Hospital

  https://www.livhospital.com/en/pectus-excavatum

  A CT scan provides a more detailed view of the chest, allowing for precise measurements of the indentation. It can also show how the condition might be affecting the heart, lungs, and surrounding structures. […] An MRI is sometimes used to evaluate the heart and lungs’ function more closely. It offers detailed images of soft tissues, which can be helpful in understanding any impacts on cardiac or pulmonary function. […] An echocardiogram uses ultrasound waves to produce images of the heart. It may be used to assess whether the condition is affecting heart function, such as causing displacement or compression of the heart. […] These tests are used to measure lung capacity and the efficiency of breathing. They can help determine if pectus excavatum is affecting the individual’s lung function, especially in cases where there are symptoms like shortness of breath or fatigue. […] Barlow’s Test is a physical exam technique used to estimate the severity of the chest depression by measuring the depth of the indentation.

• #13 Pectus Excavatum | Children’s Hospital Colorado

  https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/pectus-excavatum/

  Once your child’s CT scan is completed, your child’s doctor will calculate the Haller index. This is also known as the CT pectus index. A normal ratio is 1.50 to 2.0. A value higher than 2.0 indicates that a child has pectus excavatum. The higher the number, the more severe the deformity. A child with a CT pectus index greater than 3.2 means they have severe pectus excavatum and surgery can be considered.

• #14 Pectus excavatum evaluation, surgery – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/pectus-excavatum-hollow-chest

  In Latin, pectus excavatum translates to „chest hollow.” This term describes a condition in which the chest is sunken in the center or to one side. […] Evaluation is important to determine whether the appearance of the chest results from a weakness of the chest wall or a deformity, such as pectus excavatum. […] The severity of the condition can range from mild to severe. A measurement called the Haller index is used to grade the severity. […] Typically, a chest X-ray measures the width of the chest inside the rib cage and the depth of the chest from the back of the sternum to the vertebrae of the spine. […] On occasion, additional imaging, such as a CT scan is required to measure for Haller index accurately. […] For a person who does not have pectus excavatum, the Haller index number is around 2.5 cm. A moderate condition level would have an index of 3.25 cm or higher.

• #15 Pectus Excavatum Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/1004953-workup

  Recent studies have demonstrated that the severity of the pectus excavatum deformity (as detected by the CT scan) directly correlates with the degree of restrictive lung disease caused by the pectus excavatum. […] In cases with significant asymmetry, CT scanning can provide valuable information for planning the operative intervention and can also provide helpful information regarding the asymmetric volume difference between the right and left hemithorax. […] Many patients with pectus excavatum have some degree of rib hypoplasia, which may cause one hemithorax to be much smaller than the other. […] Cardiac function and morphology can be easily assessed with noninvasive methods such as echocardiography. […] Unless the patient has symptoms, echocardiography is not mandatory in the workup of patients with pectus excavatum.

• #16 Pectus Excavatum | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/pectus-excavatum

  Pectus excavatum is diagnosed by a thorough health history and physical examination. Diagnostic imaging tests are used to get a detailed look at your child’s condition. […] A CT scan of the chest is essential as it provides the Haller index. The Haller index is the ratio between the transverse chest diameter (measurement from one side of the ribcage to the other) and the anteroposterior diameter (measurement from the breastbone to the spinal cord) of the chest. […] A normal chest ratio is approximately 2.5 cm and an index over 3.2 cm is often defined as severe and eligible for the Nuss procedure. The chest CT will also show any displacement or compression of the heart. […] For children and adolescents, it’s especially important to have imaging tests done at an institution with pediatric radiologists who specialize in low-dose imaging techniques that reduce patients’ exposure to radiation. […] Some other tests such as pulmonary function tests (PFT) or an echocardiogram may be used to determine the extent of heart and lung compression. Your insurance company may require these tests before approving surgery.

• #17 Pectus Excavatum Treatment Guide – Nuss Procedure, Funnel Chest, Sunken Chest | Cleveland Clinic

  https://pages.clevelandclinic.org/pectus-excavatum-index.html

  Cleveland Clinic Childrens is one of few hospitals nationally that treats both pectus excavatum and pectus carinatum. […] Pectus excavatum is an abnormal development of the rib cage where the breastbone grows inward, resulting in a sunken chest wall. Commonly known as sunken chest or funnel chest. […] Learn more about pectus excavatum and carinatum by downloading our free treatment guide. The guide includes information on: […] Symptoms and diagnosis […] Treatment options including bracing and the Nuss procedure.

• #18 Pectus Excavatum | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/pectus-excavatum

  Pectus excavatum is usually diagnosed during a physical examination. X-rays of the chest can help your child’s doctor confirm the diagnosis. […] At Boston Children’s Hospital, we also use a white light scanner — a type of three-dimensional (3D) camera — to help measure your child’s chest wall depression and monitor their response to treatment over time. […] Other recommended tests might include: Echocardiogram (also known as cardiac ultrasound), Pulmonary function test (PFT), Cardiopulmonary exercise test (CPET).

• #19 Pectus and Chest Wall Treatment Program | Boston Children’s Hospital

  https://www.childrenshospital.org/programs/pectus-and-chest-wall-treatment-program

  White light scanning creates three-dimensional (3D) images of the chest. This provides the most accurate chest wall measurements while also decreasing exposure to radiation through CT scanning, X-rays, and other diagnostic imaging. […] For many children with mild to moderate pectus excavatum or pectus carinatum, vacuum bell therapy or bracing can make surgery unnecessary. […] For patients with pectus excavatum which is severe or those whose condition does not improve through non-surgical treatment, we offer a minimally invasive repair known as the Nuss procedure. […] We utilize cryoablation during surgery to help minimize post-operative pain. […] Patient safety and comfort are our top priorities anytime a chest wall issue requires surgical treatment. […] Our Pectus and Chest Wall Program works closely with a variety of different specialties within Boston Children’s Hospital.

• #20 Pectus Excavatum | Columbia Surgery

  https://columbiasurgery.org/conditions-and-treatments/pectus-excavatum

  Pectus excavatum is a condition in which the chest wall is sunken in, creating a caved-in appearance. […] Pectus excavatum can compromise lung and heart capacity, especially when the condition is severe, causing fatigue, shortness of breath, chest pain, and a fast heartbeat. […] Multiple tools are used to diagnose pectus excavatum and gauge its extent, including: Visual examination of the chest, Auscultation analysis of sounds of the heart and chest to detect the condition’s effect on heart and lung function, Electrocardiogram (ECG, also called EKG), Echocardiogram (a noninvasive test that takes a picture of the heart with sound waves), Pulmonary function testing (breathing into a mouthpiece connected to an instrument that measures the amount of air breathed over a period of time), Chest X-ray, CT-scan, Haller Index: A measure of the extent of pectus excavatum by means of the CT scan. It is calculated by obtaining the ratio of the horizontal distance of the inside of the ribcage and the shortest distance between the vertebrae and sternum. A Haller Index of greater than 3.25 is generally considered severe (a normal Haller Index is 2.5).

• #21 An Extensive Guide to Pectus Excavatum | Find Expert AdviceTwitterTwitter

  https://www.stephenmcculley.co.uk/resource-centre/other-procedures/causes-symptoms-surgery-pectus-excavatum/

  Pectus excavatum is a condition that causes the rib cage to grow abnormally and pushes the sternum inwards. […] How is pectus excavatum diagnosed? […] Usually, a visual examination is enough to diagnose pectus excavatum. To find out the severity of your pectus excavatum and whether it has an impact on your heart and lungs, you’ll need to have several tests. These may include the following: Chest x-ray, CT (computerised tomography) scan, ECG, Echocardiogram of the heart (similar to an ultrasound), Lung function tests, Exercise test. […] Pectus excavatum is usually diagnosed in childhood but many people don’t realise they have it until they are teenagers or older. Patients who are diagnosed at a later age can still have surgery to correct the deformity if it’s affecting their quality of life.

• #22 Pectus Excavatum Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/1004953-workup

  Recent studies have demonstrated that the severity of the pectus excavatum deformity (as detected by the CT scan) directly correlates with the degree of restrictive lung disease caused by the pectus excavatum. […] In cases with significant asymmetry, CT scanning can provide valuable information for planning the operative intervention and can also provide helpful information regarding the asymmetric volume difference between the right and left hemithorax. […] Many patients with pectus excavatum have some degree of rib hypoplasia, which may cause one hemithorax to be much smaller than the other. […] Cardiac function and morphology can be easily assessed with noninvasive methods such as echocardiography. […] Unless the patient has symptoms, echocardiography is not mandatory in the workup of patients with pectus excavatum.

• #23 Pectus Excavatum: A Review of Diagnosis and Current Treatment Options

  https://www.degruyter.com/document/doi/10.7556/jaoa.2017.021/html?lang=en

  A 12-lead electrocardiogram should be ordered for all patients. Abnormalities in electrocardiogram results, most commonly right bundle branch block and signs of atrial and ventricular hypertrophy, are frequently seen in patients with PE. […] Although transthoracic imaging may be limited in patients with severe anomalies, echocardiography should be performed to rule out substantial anatomic abnormalities. […] One analyte has been found to be consistently abnormal in patients with PE: LDH. In patients with PE, LDH can be elevated, but it decreases after correction. […] To quantify the degree to which PE is affecting a patients ability to exercise and consume oxygen, cardiopulmonary exercise testing should be performed. […] In general, pulmonary function is not substantially abnormal in most patients with PE.

• #24 Pectus Excavatum: A Review of Diagnosis and Current Treatment Options

  https://www.degruyterbrill.com/document/doi/10.7556/jaoa.2017.021/html?lang=en&srsltid=AfmBOop_p3qeFelnSmoRR2DAmW04aQGzCDTSkvisEj_5_aBW97k2zHWv

  A 12-lead electrocardiogram should be ordered for all patients. Abnormalities in electrocardiogram results, most commonly right bundle branch block and signs of atrial and ventricular hypertrophy, are frequently seen in patients with PE. […] Although transthoracic imaging may be limited in patients with severe anomalies, echocardiography should be performed to rule out substantial anatomic abnormalities. This imaging is critical for patients who are suspected of having Marfan syndrome to assess aortic dimensions and mitral valve function. […] To quantify the degree to which PE is affecting a patients ability to exercise and consume oxygen, cardiopulmonary exercise testing should be performed. Cardiac limitations resulting from the malformation can be demonstrated by an abnormally low maximum anaerobic Vo2 level during exercise testing.

• #25 Pectus excavatum: Treatment – UpToDate

  https://www.uptodate.com/contents/pectus-excavatum-treatment

  Pectus excavatum (PE) is a deformity of the chest wall characterized by sternal depression, which typically begins over the midportion of the manubrium and progressing inward through the xiphoid process. […] The clinical significance of PE depends on three issues: […] Severity of the chest wall defect […] Cardiopulmonary morbidity […] Psychosocial impact of the defect and its appearance on the patient.

• #26 Pectus Excavatum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430918/

  Approximately 95 percent of congenital chest wall anomalies are attributed to pectus deformities, with pectus excavatum being the most common. […] This activity examines the differential of pectus excavatum and how to properly evaluate a patient with pectus excavatum, and highlights the role of the interprofessional team in caring for patients with this condition. […] Describe a complete evaluation of pectus excavatum, including any appropriate diagnostic imaging. […] The lateral view of the chest radiograph clearly demonstrates the sternal defect. Additional imaging studies may reveal displaced vertebral bodies and varying degrees of scoliosis. […] Complete evaluation includes chest radiograph, pulmonary function testing (spirometry, plethysmography, respiratory muscle strength assessment), electrocardiogram, and echocardiogram to assess for the secondary or associated anomalies of a clinical syndrome.

• #27 Pectus excavatum | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20248760/

  Electrocardiogram. An electrocardiogram can show whether the hearts rhythm is regular or not. It also can show whether the electrical signals that control the heartbeat are timed properly. To do the test, a healthcare professional places sticky patches called electrodes on the chest. Wires connect the patches to a computer that prints or shows results. […] Echocardiogram. An echocardiogram can show real-time images of how well the heart and heart valves are working. To do the test, a healthcare professional presses a wand against the chest. The wand gives off sound waves that make pictures of the heart. An echocardiogram also shows whether the chest wall may be affecting heart function and the flow of blood through the heart. […] Lung function tests. These types of tests measure the amount of air that the lungs can hold. They also measure how quickly the lungs can push out air. […] Exercise function test. This test tracks how well the heart and lungs work during exercise, usually on a bike or treadmill.

• #28

• #29 Pectus Excavatum: A Review of Diagnosis and Current Treatment Options

  https://www.degruyterbrill.com/document/doi/10.7556/jaoa.2017.021/html?lang=en&srsltid=AfmBOop_p3qeFelnSmoRR2DAmW04aQGzCDTSkvisEj_5_aBW97k2zHWv

  Osteopathic medicine places a special emphasis on the musculoskeletal system, and understanding how chest wall structure may influence function is critical. Pectus excavatum is a common congenital chest wall defect in which the sternum is depressed posteriorly. Patients may present with complaints of chest wall discomfort, exercise intolerance, and tachycardia. The medical implications, diagnosis, and treatment options for patients with pectus excavatum are reviewed. […] When a patient presents with PE, an evaluation should be completed to understand the severity of the condition and determine treatment options. A thorough workup is indicated in patients with symptoms and can include history and physical examination; thoracic imaging (eg, inspiratory and expiratory computed tomography, magnetic resonance imaging, electrocardiography, echocardiography); blood chemistry analysis (eg, basic metabolic profile, complete blood cell count, lactate dehydrogenase [LDH] level); cardiopulmonary exercise testing through measurement of maximum oxygen consumption (Vo2); and pulmonary function tests.

• #30 Pectus Excavatum: A Review of Diagnosis and Current Treatment Options

  https://www.degruyterbrill.com/document/doi/10.7556/jaoa.2017.021/html?lang=en&srsltid=AfmBOop_p3qeFelnSmoRR2DAmW04aQGzCDTSkvisEj_5_aBW97k2zHWv

  A 12-lead electrocardiogram should be ordered for all patients. Abnormalities in electrocardiogram results, most commonly right bundle branch block and signs of atrial and ventricular hypertrophy, are frequently seen in patients with PE. […] Although transthoracic imaging may be limited in patients with severe anomalies, echocardiography should be performed to rule out substantial anatomic abnormalities. This imaging is critical for patients who are suspected of having Marfan syndrome to assess aortic dimensions and mitral valve function. […] To quantify the degree to which PE is affecting a patients ability to exercise and consume oxygen, cardiopulmonary exercise testing should be performed. Cardiac limitations resulting from the malformation can be demonstrated by an abnormally low maximum anaerobic Vo2 level during exercise testing.

• #31 Pectus Excavatum: A Review of Diagnosis and Current Treatment Options

  https://www.degruyter.com/document/doi/10.7556/jaoa.2017.021/html?lang=en

  A 12-lead electrocardiogram should be ordered for all patients. Abnormalities in electrocardiogram results, most commonly right bundle branch block and signs of atrial and ventricular hypertrophy, are frequently seen in patients with PE. […] Although transthoracic imaging may be limited in patients with severe anomalies, echocardiography should be performed to rule out substantial anatomic abnormalities. […] One analyte has been found to be consistently abnormal in patients with PE: LDH. In patients with PE, LDH can be elevated, but it decreases after correction. […] To quantify the degree to which PE is affecting a patients ability to exercise and consume oxygen, cardiopulmonary exercise testing should be performed. […] In general, pulmonary function is not substantially abnormal in most patients with PE.

• #32 Pectus Excavatum: A Review of Diagnosis and Current Treatment Options

  https://www.degruyter.com/document/doi/10.7556/jaoa.2017.021/html?lang=en

  A 12-lead electrocardiogram should be ordered for all patients. Abnormalities in electrocardiogram results, most commonly right bundle branch block and signs of atrial and ventricular hypertrophy, are frequently seen in patients with PE. […] Although transthoracic imaging may be limited in patients with severe anomalies, echocardiography should be performed to rule out substantial anatomic abnormalities. […] One analyte has been found to be consistently abnormal in patients with PE: LDH. In patients with PE, LDH can be elevated, but it decreases after correction. […] To quantify the degree to which PE is affecting a patients ability to exercise and consume oxygen, cardiopulmonary exercise testing should be performed. […] In general, pulmonary function is not substantially abnormal in most patients with PE.

• #33 Pectus excavatum: Overview, symptoms, treatments, and more

  https://www.medicalnewstoday.com/articles/pectus-excavatum

  People with pectus excavatum may have elevated levels of lactate dehydrogenase (LDH) in their blood. […] It is common for people with pectus excavatum to experience restrictive lung function. […] A doctor will evaluate a persons physical appearance and symptoms to determine the severity of the condition and choose the most suitable treatment option. […] A doctor may recommend surgery if a persons symptoms are causing cosmetic concerns related to appearance or other health complications that affect daily life. […] Research from 2016 suggests that a person may be eligible for surgery if they meet any two of the following criteria: […] A pediatric or cardiothoracic surgeon a doctor specializing in operating on the heart, lungs, and other structures in the thoracic cavity can perform this surgery. […] Surgery can improve the quality of life of people with severe symptoms, self-image concerns, or both.

• #34 Pectus Excavatum – Diagnosis & Treatment

  https://www.upmc.com/services/esophageal-lung-surgery-institute/conditions/pectus-excavatum

  Most people do not experience symptoms with pectus excavatum, causing some to consider it only a cosmetic deformity. […] A primary care doctor, along with a thoracic surgeon and pulmonology specialist, will conduct a complete physical and order a comprehensive panel of blood tests to confirm a diagnosis of pectus excavatum. […] Depending on the severity of the defect and the results of the exams and blood work, the medical team may order a number of other tests, such as: Echocardiogram (image of the heart), Electrocardiogram (EKG), Computerized tomography (CT) scan of the chest, MRI of the chest, X-ray of the chest, Genetic testing, Enzyme assays, Metabolic studies, Pulmonary (lung) function tests.

• #35 Pediatric Pectus Excavatum | Memorial Hermann

  https://memorialhermann.org/services/conditions/pediatric-pectus/pectus-excavatum

  Pectus excavatum is often diagnosed by the patient or their family members who notice an abnormal shape of the chest. […] The majority of pectus excavatum cases are not associated with other conditions. However, tests may be done to rule out other suspected disorders, including Marfan syndrome, a connective tissue disorder that causes long limbs, curvature of the spine and chest abnormalities; Poland syndrome, a disorder marked by missing or abnormal muscle development on one side of the chest and abnormalities of the hand; scoliosis or curvature of the spine; or rickets, which results from a lack of vitamin D or calcium and not enough exposure to sunlight, which interferes with normal bone growth. These tests may include chromosome and metabolic studies, enzyme assays and x-rays.

• #36 Pectus Excavatum Symptoms, Causes, and Treatment | Liv Hospital

  https://www.livhospital.com/en/pectus-excavatum

  A CT scan provides a more detailed view of the chest, allowing for precise measurements of the indentation. It can also show how the condition might be affecting the heart, lungs, and surrounding structures. […] An MRI is sometimes used to evaluate the heart and lungs’ function more closely. It offers detailed images of soft tissues, which can be helpful in understanding any impacts on cardiac or pulmonary function. […] An echocardiogram uses ultrasound waves to produce images of the heart. It may be used to assess whether the condition is affecting heart function, such as causing displacement or compression of the heart. […] These tests are used to measure lung capacity and the efficiency of breathing. They can help determine if pectus excavatum is affecting the individual’s lung function, especially in cases where there are symptoms like shortness of breath or fatigue. […] Barlow’s Test is a physical exam technique used to estimate the severity of the chest depression by measuring the depth of the indentation.

• #37 Pectus Excavatum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430918/

  The Haller index (HI) is the standard upon which to quantify the severity of a pectus excavatum deformity. […] Surgical (pediatric or cardiothoracic) consultation should be sought for all patients with a Haller Index of 2.5 or greater, as well as for patients with concomitant cardiac defects that need surgical repair or decreased pulmonary reserve. […] Regardless of the Haller index measure, impaired cardiopulmonary function is an indication for surgical correction. […] Surgical correction of the funnel chest attributed to a pectus excavatum defect significant improves pulmonary function at rest and VO2 max in cases in which the Hallex index measures greater than 3.2.

• #38 Pectus Excavatum: A Review of Diagnosis and Current Treatment Options

  https://www.degruyterbrill.com/document/doi/10.7556/jaoa.2017.021/html?lang=en&srsltid=AfmBOop_p3qeFelnSmoRR2DAmW04aQGzCDTSkvisEj_5_aBW97k2zHWv

  Surgical procedures are recommended for patients with severe PE as noted by a Haller Index score of more than 3.25 or a correction index score of more than 20%. […] Pectus excavatum can recur after any type of surgical repair, and the risk varies based on the patients age, type and severity of PE, and the presence of underlying connective tissue disorders.

• #39 Pectus Excavatum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430918/

  The Haller index (HI) is the standard upon which to quantify the severity of a pectus excavatum deformity. […] Surgical (pediatric or cardiothoracic) consultation should be sought for all patients with a Haller Index of 2.5 or greater, as well as for patients with concomitant cardiac defects that need surgical repair or decreased pulmonary reserve. […] Regardless of the Haller index measure, impaired cardiopulmonary function is an indication for surgical correction. […] Surgical correction of the funnel chest attributed to a pectus excavatum defect significant improves pulmonary function at rest and VO2 max in cases in which the Hallex index measures greater than 3.2.

• #40 Pectus Excavatum: A Review of Diagnosis and Current Treatment Options

  https://www.degruyterbrill.com/document/doi/10.7556/jaoa.2017.021/html?lang=en&srsltid=AfmBOop_p3qeFelnSmoRR2DAmW04aQGzCDTSkvisEj_5_aBW97k2zHWv

  Surgical procedures are recommended for patients with severe PE as noted by a Haller Index score of more than 3.25 or a correction index score of more than 20%. […] Pectus excavatum can recur after any type of surgical repair, and the risk varies based on the patients age, type and severity of PE, and the presence of underlying connective tissue disorders.

• #41 Pectus excavatum evaluation, surgery – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/pectus-excavatum-hollow-chest

  Surgery becomes an important treatment option for a Haller Index greater than 3.25 cm. […] Surgery stops the sternum from pushing on the heart and lungs, allowing for better breathing. […] While children can be self-conscious about the shape of the chest, most patients are healthier after surgery to correct pectus excavatum. […] After the sternum is put in the correct position using a metal bar, children may have improved breathing and increased endurance with exercise.

• #42 Pectus Excavatum: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17328-pectus-excavatum

  Pectus excavatum is a congenital condition, which means you’re born with it. […] Healthcare providers can correct pectus excavatum with minimally invasive surgery or traditional open surgery. […] A healthcare provider can diagnose pectus excavatum with a simple physical examination. Providers may not notice the issue until you’re in your early teens. They may want to do testing to see how much pectus excavatum is affecting your cardiopulmonary (heart and lung) function. […] Tests for pectus excavatum may include: Magnetic resonance imaging (MRI) of your chest, Computed tomography (CT) of your chest, Cardiopulmonary (heart and lungs) exercise testing, Electrocardiogram (EKG), Echocardiogram, Pulmonary function tests (PFTs). […] A surgeon can correct pectus excavatum with a minimally invasive (Nuss procedure) or an open (Ravitch procedure) operation. Your surgeon will discuss which procedure is best for you.

• #43 Pectus Excavatum: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17328-pectus-excavatum

  The goal of pectus excavatum repair is to relieve pressure on your heart and lungs so they can work better. This typically improves breathing, exercise intolerance and chest pain. […] Both the Nuss and Ravitch procedures have excellent results. People are almost always satisfied with the way they feel and look after recovery. The rate of the condition recurring (happening again) is less than 1% for both procedures.

• #44 Enhancing pectus excavatum diagnosis with an automated batch evaluation tool for chest computed tomography images | Scientific Reports

  https://www.nature.com/articles/s41598-024-73880-0

  We aimed to implement a fully automatic computed tomography (CT) image-detection programming algorithm as a pectus excavatum (PE) diagnostic tool, facilitating comprehensive chest wall deformity evaluation. […] The HI, first proposed by Haller et al., is the most commonly adopted measurement index used for the diagnosis and evaluation of PE severity in clinical practice. […] Our automatic PE diagnostic tool demonstrated high accuracy; four chest wall deformity indices were obtained simultaneously without any initial manual marking, correlating well with manual measurements. […] The aim of our programming algorithm is to automatically calculate the indices of every slide of a chest CT image in a single program execution, thereby identifying the extremum values, especially of the HI, which remains the diagnostic criterion in current clinical practice. […] Our algorithm is the only automatic PE diagnostic tool that has been verified using anthropomorphic phantoms.

• #45 Enhancing pectus excavatum diagnosis with an automated batch evaluation tool for chest computed tomography images | Scientific Reports

  https://www.nature.com/articles/s41598-024-73880-0

  We aimed to implement a fully automatic computed tomography (CT) image-detection programming algorithm as a pectus excavatum (PE) diagnostic tool, facilitating comprehensive chest wall deformity evaluation. […] The HI, first proposed by Haller et al., is the most commonly adopted measurement index used for the diagnosis and evaluation of PE severity in clinical practice. […] Our automatic PE diagnostic tool demonstrated high accuracy; four chest wall deformity indices were obtained simultaneously without any initial manual marking, correlating well with manual measurements. […] The aim of our programming algorithm is to automatically calculate the indices of every slide of a chest CT image in a single program execution, thereby identifying the extremum values, especially of the HI, which remains the diagnostic criterion in current clinical practice. […] Our algorithm is the only automatic PE diagnostic tool that has been verified using anthropomorphic phantoms.

• #46 Current Management of Pectus Excavatum: A Review and Update of Therapy and Treatment Recommendations | American Board of Family Medicine

  https://www.jabfm.org/content/23/2/230

  Pectus excavatum (PE) is a posterior depression of the sternum and adjacent costal cartilages and is frequently seen by primary care providers. PE accounts for 90% of congenital chest wall deformities. Patients with PE are often dismissed by physicians as having an inconsequential problem; however, it can be more than a cosmetic deformity. Severe cases can cause cardiopulmonary impairment and physiologic limitations. Evidence continues to present that these physiologic impairments may worsen as the patient ages. Data reports improved cardiopulmonary function after repair and marked improvement in psychosocial function. […] The presentation of a patient with PE warrants a thorough workup to access the significance of the defect. This workup does not necessarily include every possible physiologic test, but can include those necessary to determine whether the patient should be referred to a surgeon for a discussion of repair options.

• #47 Current Management of Pectus Excavatum: A Review and Update of Therapy and Treatment Recommendations | American Board of Family Medicine

  https://www.jabfm.org/content/23/2/230

  Surgical correction of PE can be performed safely with minimal risk. Referral for consideration of surgical treatment for severe cases should be made. Operation for correction of PE is readily accomplished in teenagers, who are close to the age of skeletal maturity. […] In general, referral to a surgeon for consultation should occur when a patient demonstrates any of the criteria listed in Table 2. Most patients will be considered for surgical correction if they demonstrate at least 2 of the listed criteria. […] Surgical repair of PE has evolved significantly during the past 50 years. There are a variety of techniques that have been successfully used, but the 2 most common methods include modifications of the open approach, first described by Ravitch, and the Nuss, or minimally invasive, approach. […] The philosophy of PE deformity has evolved as more data and treatment experience has accrued. PE is no longer felt to be just a cosmetic deformity but physicians may continue to base their recommendations for surgery on limited and preconceived knowledge from the past.

• #48 Pectus Excavatum | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/pectus-excavatum

  Pectus excavatum is usually diagnosed during a physical examination. X-rays of the chest can help your child’s doctor confirm the diagnosis. […] At Boston Children’s Hospital, we also use a white light scanner — a type of three-dimensional (3D) camera — to help measure your child’s chest wall depression and monitor their response to treatment over time. […] Other recommended tests might include: Echocardiogram (also known as cardiac ultrasound), Pulmonary function test (PFT), Cardiopulmonary exercise test (CPET).

• #49 Pectus Excavatum | Columbia Surgery

  https://columbiasurgery.org/conditions-and-treatments/pectus-excavatum

  Pectus excavatum is a condition in which the chest wall is sunken in, creating a caved-in appearance. […] Pectus excavatum can compromise lung and heart capacity, especially when the condition is severe, causing fatigue, shortness of breath, chest pain, and a fast heartbeat. […] Multiple tools are used to diagnose pectus excavatum and gauge its extent, including: Visual examination of the chest, Auscultation analysis of sounds of the heart and chest to detect the condition’s effect on heart and lung function, Electrocardiogram (ECG, also called EKG), Echocardiogram (a noninvasive test that takes a picture of the heart with sound waves), Pulmonary function testing (breathing into a mouthpiece connected to an instrument that measures the amount of air breathed over a period of time), Chest X-ray, CT-scan, Haller Index: A measure of the extent of pectus excavatum by means of the CT scan. It is calculated by obtaining the ratio of the horizontal distance of the inside of the ribcage and the shortest distance between the vertebrae and sternum. A Haller Index of greater than 3.25 is generally considered severe (a normal Haller Index is 2.5).

• #50 Pectus Excavatum | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/pectus-excavatum

  Pectus excavatum is a deformity that occurs in approximately one out of 1,000 children. […] How is Pectus Excavatum Diagnosed? Chest wall deformities can be evident in infancy, but many also develop or become more obvious as children grow. Abnormalities are usually noted by the parents, but may be evident only to the physician and found during routine chest examination. […] The optimal ages for chest wall deformity referrals are between 10 and 12 years. Patients are examined earlier if parents or the primary care physician have questions. […] If patients are diagnosed after adolescence, they can still be examined to determine what their options are given the severity of the deformity.

• #51 Pectus Excavatum: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1004953-overview

  Many patients with pectus excavatum are asymptomatic from a functional standpoint. The degree of cardiopulmonary impairment caused by lung compression and the level of cardiac displacement that results from the caved-in chest are subjects of controversy. […] The long-term health risks of patients who are managed without surgery are not known. […] Because of the recent advances in the operative repair of pectus excavatum, education of medical professionals and the public is important. Again, patients with pectus excavatum should be referred to a surgeon experienced in the field of congenital chest wall malformations. Early assessment and follow-up is essential to maximize good outcomes.

Zobacz więcej