Pectus excavatum

One of the more common chest wall anomalies seen in children is pectus excavatum, which may present at birth, or more commonly during the teenage growth spurt. Symptoms of lack of endurance, shortness of breath with exercise, or chest pain are frequent. Although pectus excavatum may be a component of some uncommon syndromes, patients usually are healthy. Evaluation should include careful anatomic description with photographs, radiography to demonstrate the depth of the depression, extent of cardiac compression, or displacement, measurement of pulmonary function. Indications for surgical treatment include two or more of the following: a severe, symptomatic deformity; progression of deformity; paradoxical respiratory chest wall motion; computer tomography scan with a pectus index greater than 3.25; cardiac compression/displacement and/or pulmonary compression; pulmonary restrictive disease; mitral valve prolapse; or failed previous repair(s). The correlation between diaphragmatic hernia and the appearance of pectus excavatum, from etiopathogenesis point of view, may be attributable to several hypotheses: excessive tension in the plastic reconstruction of the diaphragmatic defect; absence of the flexibility of the thoracic cage when goretex patchs are used for the correction of the defect; use of the thoracotomy in the correction of the defect; secondary ipoplasia of the hemithorax due to ipsilateral lung ipoplasia. In our experience 36% of cases of congenital diaphragmatic hernia are complicated by PE.