DDx
Media Gallery
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A 16-year-old boy with severe pectus excavatum. Note the appearance of the caved-in sternum and lower ribs.
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A 10-year-old girl with severe pectus excavatum. In girls, the deformity is of particular concern because of the medial displacement of the breast, resulting in significant asymmetry of the breasts and nipples (cross-eyed appearance of the nipples).
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A 10-year-old girl with severe pectus excavatum. Note the significant asymmetry of the breasts and nipples (cross-eyed appearance of the nipples).
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A 12-year-old girl with severe pectus excavatum. Note the significant asymmetry of the breasts. Preoperative photograph.
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A 12-year-old girl with severe pectus excavatum immediately after minimally invasive repair. Note the immediate correction of the deformity.
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Preoperative photograph of a 12-year-old boy prior to minimally invasive repair of pectus excavatum.
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A 12-year-old boy 2 weeks after minimally invasive repair of his pectus excavatum. Note the small lateral chest wall incision and the excellent appearance of the anterior chest with 100% correction of the pectus deformity.
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Preoperative CT scan of the chest of 12-year-old girl with severe pectus excavatum (see Media file 5). Note the severe pectus excavatum with compression of the lung fields and complete displacement of the heart and mediastinal structures to the left hemi-thorax.
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Illustration showing the minimally invasive technique for correction of pectus excavatum (3) with thoracoscopy (1). Note the long clamp passed from one side to the other (2) grabbing the umbilical tape (4), which serves as a guide for passage of the pectus bar behind the sternum.
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Operative diagram illustrating the pectus bar after it has been passed behind the sternum (5), under thoracoscopic visualization (1), before turning it over. Note that the concavity of the bar is facing up.
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Illustration of the pectus bar passed behind the sternum before and after it is turned over. The insert shows the proper technique for fixation of the pectus bar against the lateral chest wall musculature.
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Illustration of the placement of the third point of fixation for stabilization of the pectus bar. Note that the nonabsorbable suture is placed around the bar and around a rib, lateral to the sternum on the anterior chest wall.
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Operative diagram illustrating one of the open techniques for correction of pectus excavatum. The drawing is of the so-called "turn-over operation" for repair of pectus. It shows the extensive dissection and the radical nature of this open technique for surgical correction of this congenital chest wall deformity.
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Operative photograph of the open Ravitch technique for repair of pectus excavatum. The anterior chest is exposed through an anterior thoracic incision and, after raising muscle and skin flaps, each involved cartilage is excised with preservation of the perichondrium. The picture shows one of the cartilages being removed.
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Operative photograph of the completed Ravitch procedure for correction of pectus excavatum. Note the sternum fractured at 2 different points with a cartilage graft in place to maintain its new position. The involved ribs underwent perichondrial excision. The deformity is completely corrected.
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Closure of the anterior chest wall incision used for the open type of repair of pectus excavatum (Ravitch operation). Note the drain (small tubing) coming out on the side of the chest. Drains are typically removed after 2-3 days, and they prevent the accumulation of fluid under the skin and muscle flaps created at the time of surgery.
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Chest radiograph of a 16-year-old patient in which the bar was displaced superiorly and the 2 stabilizers were separated from the Lorenz pectus bar as a result of intense physical activity during soccer practice.
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Skin rash secondary to a rare case of metal allergy caused by the pectus bar.
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Recurrent pectus excavatum in a 24-year-old adult patient who underwent open repair using the Ravitch technique at age 10 years.
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Chest CT scan of the recurrent pectus excavatum in the patient in Media file 20.
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Recurrent pectus excavatum in young adult female patient who underwent minimally invasive repair at age 8 years.
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Technique for pectus bar bending. The Lorenz bar is bent by the operating surgeon at the time of pectus bar placement using an instrument known as the "bar bender." A smooth curvature is given to the bar so that it fits under the sternum and corrects the pectus deformity.
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Pectus bars of various sizes.
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Technique for removal of the pectus bar. The bar and lateral stabilizer are easily exposed through the old lateral incision in the chest. Once exposed, it is pulled out using a bone-hook instrument.
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Technique for removal of the pectus bar. The bar is pulled out using a bone-hook instrument.
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