Pectus Excavatum

  • Etiology: Congenital depression of sternum
  • Imaging: Haller index is:
    — Transverse diameter of chest (inner rib to inner rib) divided by AP diameter of chest (back of sternum to anterior part of vertebral body) where chest is narrowest
    — Lines should be perpendicular to each other
    — Haller index needs to be greater than 3.25 for surgery to be useful
  • DDX:
  • Complications:
  • Treatment: Corrected by Nuss bar
  • Clinical: Can have chest pain from sternum rubbing against parietal pericardium or shortness of breath

Radiology Cases of Pectus Excavatum

CXR and CT of pectus excavatum
CXR PA and lateral and axial CT without contrast of the chest shows marked depression of the sternum posteriorly leading to deformation of the chest wall.
CT of pectus excavatum
3D reconstruction from a CT without contrast of the chest (above) and an axial CT from the same exam (below) shows posterior indentation of the sternum towards the spine. The Haller index was calculated to be 5.3.
CT of pectus excavatum
Axial CT without contrast of the chest shows a marked depression of the sternum towards the spine. The Haller index was 4.

Radiology Cases of Pectus Excavatum After Correction With Nuss Bar

CXR of correct position of Nuss bar
CXR AP shows no evidence of pneumothorax. The Nuss bar stabilizers bilaterally are in their correct position in relation to the Nuss bar.

Clinical Cases of Pectus Excavatum

Clinical image of pectus excavatum
Clinical image shows a marked concavity of the chest wall.
Clinical image of pectus excavatum
Clinical image shows a marked concavity of the chest wall.
Clinical image of pectus excavatum
Clinical image shows marked depression of the sternum in the midline of the chest.