Pectus excavatum Totally Explained

Everything about Pectus Excavatum totally explained

Pectus excavatum (a Latin term meaning hollowed chest) is the most common congenital deformity of the anterior wall of the chest, in which several ribs and the sternum grow abnormally. This produces a caved-in or sunken appearance of the chest. It is usually present at birth and progresses during the time of rapid bone growth in the early teenage years, but in rare cases doesn't appear until the onset of puberty.
Pectus excavatum is sometimes considered to be cosmetic, however it can impair cardiac and respiratory function, and cause pain in the chest and back. People with the abnormality may experience negative psychosocial effects, and avoid activities that expose the chest.
Pectus excavatum is sometimes referred to as cobbler's chest, sunken chest, funnel chest or simply a dent in the chest.

Signs and symptoms

The hallmark of the condition is a sunken appearance of the sternum. The heart is displaced (and rotated). Mitral valve prolapse may also be present. Base lung capacity is decreased.

Pathophysiology

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's impairment of function of the cardiovascular system in individuals with pectus excavatum. While some studies have demonstrated decreased cardiovascular function in pectus excavatum, there has been no consensus reached based on newer physiological tests (such as echocardiography) of the presence or degree of impairment in cardiovascular function in people with pectus excavatum. Similarly, there's no consensus on the degree of functional improvement after corrective surgery. Lung sounds are usually clear yet diminished due to decreased base lung capacity. More recently the Haller index has been used based on CT scan measurements. 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. 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, where in pectus excavatum the spine usually appears normal in structure.

Treatment

Medical treatment is limited to surgery and ensuring defects involving the heart and/or lungs are controlled. Before operation several tests are usually to be performed. These include, but are not limited to, a CT scan, pulmonary function tests, and cardiology exams (such as auscultation and ECGs). The cardiopulmonary tests are used to determine the lung capacity and to check for heart murmurs.

Surgery

Surgical correction has been shown to repair any functional symptoms that may occur in the condition, such as respiratory problems or heart murmurs, provided that permanent damage hasn't already arisen from an extremely severe case. The Nuss procedure involves slipping in one or more concave steel bars into the chest, underneath the sternum. The bar is flipped to a convex position so as to push outward on the sternum, correcting the deformity. The bar usually stays in the body for about two years, although many surgeons are now moving toward leaving them in for up to five years. When the bones have solidified into place, the bar is removed through outpatient surgery.

Vacuum Bell

A relatively new alternative to surgery is the vacuum bell. It consists of a bowl shaped device which fits over the caved-in area; the air is then removed by the use of a hand pump. The vacuum created by this lifts the sternum upwards, lessening the severity of the deformity. As it's such a recent device there's currently no information as to whether it's effective in the long term.

Cosmetic and light treatments

The cosmetic appearance of pectus excavatum can be treated with a dermal filler called Bio-Alcamid. However, as this does nothing to alleviate the actual deformity it won't prevent any physiological symptoms caused by the condition.
Mild cases have also reportedly been treated with corset-like orthopedic support vests and exercise.
There are also prosthetic implants available to 'fill the depressed area'. Solid silicone implants have been successfully used for many years with excellent results. More recently a porex implant has been used which is a similar material used to replaced 'skull' in brain surgery and severe head injuries.

Magnetic Mini-Mover Procedure

The Magnetic Mini-Mover Procedure (3MP) is a technique used to correct pectus excavatum by using two magnets to realign the sternum with the rest of the chest and ribcage. One magnet is inserted 1cm into the patients body on the lower end of the sternum, the other is placed externally onto a custom fitted brace. These two magnets generate around 0.04 Tesla (T) in order to slowly move the sternum outwards over a number of years. The maximum Tesla that can be applied to the body safely is around 4T, making this technique safe from a magnetic viewpoint.

In Animals

Pectus excavatum is also known to occur in animals, for example the Munchkin breed of cat. Some procedures used to treat the condition in animals have not been used in humans, such as the use of a cast with sutures wrapped around the sternum and the use of internal and external splints. These techniques are generally used in immature animals with flexible cartilage.

Further Information

Get more info on 'Pectus Excavatum'.

External Link Exchanges

Do you know how hard it is to get a link from a large encyclopaedia? Well we're different and will prove it. To get a link from us just add the following HTML to your site on a relevant page:

<a href="http://pectus_excavatum.totallyexplained.com">Pectus excavatum Totally Explained</a>

Then simply click through this link from your web page. Our crawlers will verify your link, extract the title of your web page and instantly add a link back to it. If you like you can remove the words Totally Explained and embed the link in article text.
As long as your link remains in place, we'll keep our link to you right here. Please play fair - our crawlers are watching. Your site must be closely related to this one's topic. Any kind of spamming, dubious practises or removing the link will result in your link from us being dropped and, potentially, your whole site being banned.