Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pectus Carinatum Workup

  • Author: Mary E Cataletto, MD; Chief Editor: Michael R Bye, MD  more...
 
Updated: Oct 13, 2015
 

Imaging Studies

Radiographic imaging should include 2 view chest radiographs: posteroanterior and lateral images. A chest radiograph of a patient with pectus carinatum is shown in the image below.

Chest radiograph of a patient with pectus carinatu Chest radiograph of a patient with pectus carinatum. Radiograph courtesy of A. Fruauff, MD.

Additional imaging with either a chest CT scan or MRI may also be helpful. CT scanning of the chest in an individual with pectus carinatum (see the image below) reveals an increased anterioposterior chest wall diameter.[11]

CT scan of a patient with pectus carinatum. CT cou CT scan of a patient with pectus carinatum. CT courtesy of A. Fruauff, MD.

The Haller method may be used to determine severity index, as follows: width of the chest divided by distance between the sternum and spine at the same level; this may help to predict those individuals who will benefit from surgical intervention.

Next

Other Tests

In patients with pectus carinatum, pulmonary function studies may be tailored to address concerns about clinical symptoms and the appearance of the chest wall upon examination. Data on pulmonary and exercise physiology in patients with pectus carinatum deformities are limited. However, children with barrel chests usually have obstructive ventilatory defects. This underscores the importance of preforming complete pulmonary function testing, including prebronchodilator and postbronchodilator spirometry, lung volumes, and diffusion capacity. Exercise testing may complement these studies.

In 1982, Castile described one patient who reported exercise intolerance in his series of symptomatic pectus deformities.[12] His pulmonary function studies revealed flow rates and lung volumes within the reference range. Derveaux's 1989 series also reported a patient with no significant respiratory compromise at the time of his study.[3]

Progressive exercise studies may also be helpful in evaluating the exercise-related symptoms and exertional tolerance.

Electrocardiography and echocardiography may be considered if congenital heart disease is suspected. Iakovlev's study reported 70 patients with pectus carinatum deformity. Of these, 97% had echocardiographically documented mitral valve prolapse.[5] Hemodynamic and cardiodynamic changes were also observed in some patients, as well as decreased myocardial contractility. These abnormalities were more frequently observed in the patients with pigeon breast.

Scoliosis series may be considered if clinical features are suggestive of this diagnosis.

Chromosomal analysis and metabolic testing may also be considered if other dysmorphic signs are identified.

Previous
 
 
Contributor Information and Disclosures
Author

Mary E Cataletto, MD Professor of Clinical Pediatrics, State University of New York at Stony Brook

Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Charles Callahan, DO Professor, Chief, Department of Pediatrics and Pediatric Pulmonology, Tripler Army Medical Center

Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Chief Editor

Michael R Bye, MD Professor of Clinical Pediatrics, State University of New York at Buffalo School of Medicine; Attending Physician, Pediatric Pulmonary Division, Women's and Children's Hospital of Buffalo

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Girish D Sharma, MD, FCCP, FAAP Professor of Pediatrics, Rush Medical College; Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush Children's Hospital, Rush University Medical Center

Girish D Sharma, MD, FCCP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

References
  1. Coskun ZK, Turgut HB, Demirsoy S, Cansu A. The prevalence and effects of Pectus Excavatum and Pectus Carinatum on the respiratory function in children between 7-14 years old. Indian J Pediatr. 2010 Sep. 77(9):1017-9. [Medline].

  2. Steinmann C, Krille S, Mueller A, Weber P, Reingruber B, Martin A. Pectus excavatum and pectus carinatum patients suffer from lower quality of life and impaired body image: a control group comparison of psychological characteristics prior to surgical correction. Eur J Cardiothorac Surg. 2011 Nov. 40(5):1138-45. [Medline].

  3. Derveaux L, Clarysse I, Ivanoff I, Demedts M. Preoperative and postoperative abnormalities in chest x-ray indices and in lung function in pectus deformities. Chest. 1989 Apr. 95(4):850-6. [Medline].

  4. Fonkalsrud EW. Surgical correction of pectus carinatum: lessons learned from 260 patients. J Pediatr Surg. 2008 Jul. 43(7):1235-43. [Medline].

  5. Iakovlev VM, Nechaeva GI, Viktorova IA. [Clinical function of the myocardium and cardio- and hemodynamics in patients with pectus carinatum deformity]. Ter Arkh. 1990. 62(4):69-72. [Medline].

  6. Mielke CH, Winter RB. Pectus carinatum successfully treated with bracing. A case report. Int Orthop. 1993 Dec. 17(6):350-2. [Medline].

  7. Martinez-Ferro M, Fraire C, Bernard S. Dynamic compression system for the correction of pectus carinatum. Semin Pediatr Surg. 2008 Aug. 17(3):194-200. [Medline].

  8. Obermeyer RJ, Goretsky MJ. Chest wall deformities in pediatric surgery. Surg Clin North Am. 2012 Jun. 92(3):669-84, ix. [Medline].

  9. Calloway EH, Chhotani AN, Lee YZ, Phillips JD. Three-dimensional computed tomography for evaluation and management of children with complex chest wall anomalies: useful information or just pretty pictures?. J Pediatr Surg. 2011 Apr. 46(4):640-7. [Medline].

  10. Heithaus JL, Davenport S, Twyman KA, Torti EE, Batanian JR. An intragenic deletion of the gene MNAT1 in a family with pectus deformities. Am J Med Genet A. 2014 May. 164A (5):1293-7. [Medline].

  11. Castile RG, Staats BA, Westbrook PR. Symptomatic pectus deformities of the chest. Am Rev Respir Dis. 1982 Sep. 126(3):564-8. [Medline].

  12. Frey AS, Garcia VF, Brown RL, et al. Nonoperative management of pectus carinatum. J Pediatr Surg. 2006 Jan. 41(1):40-5; discussion 40-5. [Medline].

  13. Lee RT, Moorman S, Schneider M, Sigalet DL. Bracing is an effective therapy for pectus carinatum: interim results. J Pediatr Surg. 2013 Jan. 48(1):184-90. [Medline].

  14. Wong KE, Gorton GE 3rd, Tashjian DB, Tirabassi MV, Moriarty KP. Evaluation of the treatment of pectus carinatum with compressive orthotic bracing using three dimensional body scans. J Pediatr Surg. 2014 Jun. 49 (6):924-7. [Medline].

  15. Kobayashi S, Yoza S, Komuro Y, Sakai Y, Ohmori K. Correction of pectus excavatum and pectus carinatum assisted by the endoscope. Plast Reconstr Surg. 1997 Apr. 99(4):1037-45. [Medline].

  16. de Matos AC, Bernardo JE, Fernandes LE, Antunes MJ. Surgery of chest wall deformities. Eur J Cardiothorac Surg. 1997 Sep. 12(3):345-50. [Medline].

  17. Shamberger RC, Welch KJ. Surgical correction of pectus carinatum. J Pediatr Surg. 1987 Jan. 22(1):48-53. [Medline].

  18. Del Frari B, Schwabegger AH. Ten-year experience with the muscle split technique, bioabsorbable plates, and postoperative bracing for correction of pectus carinatum: the Innsbruck protocol. J Thorac Cardiovasc Surg. 2011 Jun. 141(6):1403-9. [Medline].

  19. Cohee AS, Lin JR, Frantz FW, Kelly RE Jr. Staged management of pectus carinatum. J Pediatr Surg. 2013 Feb. 48(2):315-20. [Medline].

  20. Bostanci K, Ozalper MH, Eldem B, Ozyurtkan MO, Issaka A, Ermerak NO. Quality of life of patients who have undergone the minimally invasive repair of pectus carinatum. Eur J Cardiothorac Surg. 2013 Jan. 43(1):122-6. [Medline].

  21. Cano I, Anton-Pacheco JL, Garcia A, Rothenberg S. Video-assisted thoracoscopic lobectomy in infants. Eur J Cardiothorac Surg. 2006 Jun. 29(6):997-1000. [Medline].

  22. Fonkalsrud EW, DeUgarte D, Choi E. Repair of pectus excavatum and carinatum deformities in 116 adults. Ann Surg. 2002 Sep. 236(3):304-12; discussion 312-4. [Medline]. [Full Text].

  23. Lacquet LK, Morshuis WJ, Folgering HT. Long-term results after correction of anterior chest wall deformities. J Cardiovasc Surg (Torino). 1998 Oct. 39(5):683-8. [Medline].

  24. O'Neill JA, Fonkalsrud EW, Coran AG, et al. Pediatric Surgery. New York, NY: Elsevier Health Sciences; 1998.

  25. Sabiston D, ed. Textbook of Surgery. Philadelphia, PA: WB Saunders Co; 1997.

  26. Westphal FL, Lima LC, Lima Neto JC, et al. Prevalence of pectus carinatum and pectus excavatum in students in the city of Manaus, Brazil. J Bras Pneumol. 2009 Mar. 35(3):221-6. [Medline].

 
Previous
Next
 
Pectus carinatum. Photograph courtesy of K. Kenigsberg, MD.
Chest radiograph of a patient with pectus carinatum. Radiograph courtesy of A. Fruauff, MD.
CT scan of a patient with pectus carinatum. CT courtesy of A. Fruauff, MD.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.