Chest wall disorders

Question 1

Types of chest wall disorders (4)

Answer 1

1) Pectus excavatum
2) Pectus carinatum
3) Poland syndrome
- missing or underdeveloped muscles on one side of the body, resulting in abnormalities that can affect the chest, shoulder, arm, and hand
4) Cleft sternum
- partial or total failure of sternal fusion at an early stage of embryological development

commonest causes

Question 2

Pectus excavatum
- Epi
- Mx

Answer 2

Epi:
- autosomal recessive
- 9:1 (male:female)
- Affects 0.3% births
- Sternovertebral space is narrowed due to precordial depression

Mx:
major deformity:
1) Modified Ravitch technique =
- involving the exposure of sternum and surrounding area,
- removal of abnormal cartilages, and
- fixation of the sternum in a more normal position with a metal bar,
- which is removed with another operation after 1y

minor deformity:
2) Nuss procedure =
- concave stainless steel bar that is slipped under the sternum
- with the assistance of a scope using two small incisions on each side of the chest.
- The bar is then flipped, and the sternum moves to the proper position

3) Rudakov technique

Surgeries should be done late teens- early 20s when main growth has stopped.

Question 3

Pectus excavatum
- Indications for surgery (9)

Answer 3

1) Aesthetic/ body image
2) Sx: Exercise intolerance, decreased endurance, exercise-induced asthma
3) Pain
4) low FVC, FEV1 or max voluntary ventilation
5) Decreased oxygen uptake
6) Echo: compression of RA/RV
7) CT Haller index >3.0
8) Calliper measurement dept >2.5cm

Question 4

Pectus carinatum
- Indications for surgery (4)

Answer 4

1) Aesthetic/ body image
2) Pain
3) Frequent injury
4) Abnormal lung function test

Question 5

What is pectus carinatum?

Answer 5

• protrusion deformities of the anterior chest wall
• causes narrowing of the transverse