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GeneralConsiderations
Congenitaldeformityofthesternumand4to5anteriorribsresultinginafunnel
shapedorsunkenanteriorchestwall
Mostcommonchestwallabnormality
Male:femaleratio3:1
Mostcasesarenoticedatbirthand90%byage1year
Familialin35%
AlsoassociatedwithMarfanandPolandSyndromes
ClinicalFindings
Mostareasymptomatic
Maybeassociatedwithmitralvalveprolapsein2060%
Pulmonaryfunctiontestscanshowarestrictivepattern
ImagingFindings
Posteriordisplacementofthelowersternum
Downwardangulationoftheanteriorribs
Apparentcardiomegalycausedbycompressionoftheheart
Absenceofthenormalrightatrialshadowtotherightofthelowerthoracicspine
Treatment
Aratioofdividingthetransversediameterofthechestbytheanteroposteriordiameter
ofmorethan3.2(theHallerIndex)maybeanindicationforcorrectivesurgery,now
oftenperformedlaparoscopicallyandutilizingminimallyinvasivesurgery
MoreprecisechestmeasurementscanbeobtainedwithCTscanningthan
conventionalradiography
PectusExcavatumDeformity.Onthefrontalprojection,thereisanaccentuated,downwardorientationoftheloweranterior
ribs(redarrow).Theheartappearsenlargedbutpartofthatappearanceistheresultofcompressionoftheheart,seen
betteronthelateralview.Therightheartborderisindistinct.Onhelateralview,thelowersternumisdepressedinward
(whitearrow),compressingtheheartbetweenitandthespine.