Pectus Carinatum Workup
- Author: Mary E Cataletto, MD; Chief Editor: Michael R Bye, MD more...
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.
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.
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.
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. 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.
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. 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.
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