Medical Specialties

Pectus Excavatum

 

 

Phoenix Children's Hospital provides comprehensive evaluations and surgical treatment for pediatric patients with pectus excavatum. We are the first children's hospital to air a live video, via social media, of the Nuss procedure being performed.

Pectus excavatum is an indentation of the chest. Other names include funnel chest, concave chest, or simply pectus. Pectus is the most common deformity of the chest wall and is seen in up to 0.8% of the population (including mild cases). It is more common in boys than in girls, by about a 5:1 ratio. Mild pectus excavatum is treated with exercise while moderate and severe deformities are candidates for surgical repair. A common misconception is that pectus abnormalities are merely a cosmetic issue. As a result, people frequently go untreated. In severe cases, the condition may compromise heart function, especially during exercise or exertion. Mild lung impairment may also be seen. Many patients experience shortness of breath and early fatigue upon attempting exercise.

A pectus excavatum evaluation includes surgical consultation, an MRI or reduced-dose CT scan of the chest, echocardiogram, pulmonary function tests, and extensive discussions with the patient and their families about the diagnosis and treatment options. Exercise testing may also be helpful in some cases.

Severity of pectus excavatum is often graded using a pectus index, also called the Haller index. The Haller index is most frequently calculated using CT measurements of the internal transverse diameter of the thorax measured between the inside of the rib cage, divided by the shortest anteroposterior depth as measured from the internal aspect of the sternum to the anterior cortex of the closest vertebral body. This is done during expiration, as an typical “breath hold” CT or MRI may falsely reduce the index. Most patients need an MRI or CT scan only if they are considered surgical candidates. An index >3.2 warrants repair if the patient is symptomatic.

Questions? Please contact Jackie Hurley at (602) 933-4246 or via email, jhurley1@phoenixchildrens.com.

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