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Skeletal Radiology

, Volume 39, Issue 8, pp 773–782 | Cite as

Pectus deformities: tomographic analysis and clinical correlation

  • Sydney Abrão Haje
  • Davi de Podestá Haje
  • Moacir Silva Neto
  • Guilherme de Souza e Cassia
  • Rodrigo Coimbra Batista
  • Gustavo Reis Alves de Oliveira
  • Tito Lívio Mundim
Scientific Article

Abstract

Objective

To assess, with computed tomography (CT) studies, features of anterior chest wall development that can be related to different types of pectus deformities.

Materials and methods

From 71 patients with pectus deformities and chest coronal CT scans, 48 (40 male and 8 female), with a mean age of 15.8 years (ranging from 5 years to 38.4 years) were selected and divided into five groups, according to clinical type of deformity and image quality. A similar CT study was performed in a sixth group of 14 individuals with no underlying pectus deformity (control group), six male and eight female, mean age 19.3 years, (range 10.8 years to 30.5 years), totaling 62 subjects. Tomographic studies were performed on a 64-section CT scanner, with parameters varied according to the subject’s body mass index (BMI). Coronal reconstructions were used to assess six features of the sternum and costal cartilages in the groups. Two other factors, a sternal index, created to estimate the sternal body width, and the sternocostal angles, were also studied.

Results

Feature I was noted in 13 patients and in no controls (P = 0.002), feature II in 39 patients and in one control (P = 0.000), feature III in 37 patients and in two controls (P = 0.002), and feature IV in two patients and in no controls (P = 0.002). The sternal index was significant to one group of patients.

Conclusion

The features studied and the index provide measurable and applicable data for the interpretation of anterior chest wall tomography, with possible implications for prognosis and treatment of different types of pectus deformities.

Keywords

Chest Deformities Imaging studies of pectus deformities Pectus carinatum Pectus excavatum Studies on the development of the anterior chest wall by computed tomography 

References

  1. 1.
    Haje SA, Harcke HT, Bowen JR. Growth disturbance of the sternum and pectus deformities: imaging studies and clinical correlation. Pediatr Radiol. 1999;29:334–41.CrossRefPubMedGoogle Scholar
  2. 2.
    Bryson V. Development of the sternum in screw tail mice. Anat Rec. 1945;91:119–41.CrossRefGoogle Scholar
  3. 3.
    Currarino G, Silverman N. Premature obliteration of the sternum sutures and pigeon breast deformity. Radiology. 1958;70:352.Google Scholar
  4. 4.
    Gabrielsen TO, Ladyman GH. Early closure of sternal sutures and congenital heart disease. AJR Am J Roentgenol. 1963;89:375–83.Google Scholar
  5. 5.
    Haje SA, Raymundo JLP. Considerações sobre deformidades da parede torácica anterior e apresentação de tratamento conservador para as formas com componentes de protrusão. Rev Bras Orthop. 1979;14:167–78.Google Scholar
  6. 6.
    Kuhn JP. The Thorax. In: Silverman FN, editor. Caffey's pediatric X-ray diagnosis. Chicago: Year Book Medical Publishers Inc; 1985. pp. 1097–9.Google Scholar
  7. 7.
    Ogden JA, Conlogue GJ, Bronson ML, et al. Radiology of postnatal skeletal development. II.The manubrium and sternum. Skeletal Radiol. 1979;4:189–95.CrossRefPubMedGoogle Scholar
  8. 8.
    Wong M, Carter DR. Mechanical stress and morphogenetic endochondral ossification of the sternum. J Bone Joint Surg Am. 1988;70:992–1000.PubMedGoogle Scholar
  9. 9.
    Haje SA, Bowen JR. Preliminary results of orthotic treatment of pectus deformities in children and adolescents. J Pediatr Orthop. 1992;12:795–800.PubMedGoogle Scholar
  10. 10.
    Haje SA. Iatrogenic pectus carinatum. Int Orthop. 1995;19:370–3.PubMedGoogle Scholar
  11. 11.
    Haje SA, Bowen JR, Harcke HT, Guttenberg ME, Bacon CR. Disorders in the sternum growth and pectus deformities: an experimental model and clinical correlation. Acta Orthop Bras. 1998;6:67–75.Google Scholar
  12. 12.
    Haje S, Haje DP. Tórax e cintura escapular. In: Hebert SK, Barros Filho TEP, Xavier R, Pardini Jr AG, editors. Ortopedia e traumatologia: princípios e prática. 4th ed. Porto Alegre: Artmed Editora; 2009. pp. 147–65.Google Scholar
  13. 13.
    Shimomura Y, Wezeman FH, Ray RD. The growth cartilage plate of the rat rib: cellular differentiation. Clin Orthop. 1973;(90):246–54.Google Scholar
  14. 14.
    Paterson AM. The Human sternum. Liverpool: Williams & Norgate, 1904.Google Scholar
  15. 15.
    Gladstone RJ, Wakeley CPG. The morphology of the sternum and its relation to the ribs. J Anat. 1932;66:508–64.PubMedGoogle Scholar
  16. 16.
    Gray H. Gray's anatomy. Carmine D. Clemente, editor. 30th American Ed. Philadelphia: Lea & Febiger; 1985.Google Scholar
  17. 17.
    Haller JA, Kramer SS, Lietman A. Use of CT scans in selection of patients for pectus excavatum surgery: a preliminary report. J Pediatr Surg. 1987;22:904–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Haje SA, Haje DP. Overcorrection during treatment of pectus deformities with DCC orthoses: experience in 17 cases. Int Orthop. 2006;30:262–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Haje SA, Haje DP. Abordagem ortopédica das deformidades pectus: 32 anos de estudos [Orthopaedic approach to pectus deformities: 32 years of studies]. Rev Bras Orthop. 2009;44:193–200.Google Scholar
  20. 20.
    Hatfield MK, Gross BH, Glazer GM, Martel W. Computed tomography of the sternum and its articulations. Skeletal Radiol. 1984;11:197–203.CrossRefPubMedGoogle Scholar
  21. 21.
    Einsiedel E, Clausner A. Funnel chest. Psychological and psychosomatic aspects in children, youngsters and young adults. J Cardiovasc Surg. 1999;40:733–6.Google Scholar

Copyright information

© ISS 2010

Authors and Affiliations

  • Sydney Abrão Haje
    • 1
    • 6
  • Davi de Podestá Haje
    • 2
  • Moacir Silva Neto
    • 3
  • Guilherme de Souza e Cassia
    • 4
  • Rodrigo Coimbra Batista
    • 5
  • Gustavo Reis Alves de Oliveira
    • 5
  • Tito Lívio Mundim
    • 4
  1. 1.Departments of Paediatric Orthopaedics and Physical Medicine and RehabilitationCentro Clínico Orthopectus, Hospital Regional da Asa Norte, Secretaria de Estado da Saúde do Distrito FederalBrasíliaBrazil
  2. 2.Department of Paediatric OrthopaedicsCentro Clínico Orthopectus, Hospital de Base do Distrito Federal, Secretaria de Estado da Saúde do Distrito FederalBrasíliaBrazil
  3. 3.Department of Physical Medicine and RehabilitationHospital Regional da Asa Norte, Secretaria de Estado da Saúde do Distrito FederalBrasíliaBrazil
  4. 4.Department of Radiology and Medical ImagingClínica Villas BoasBrasíliaBrazil
  5. 5.Department of OrthopaedicsHospital Regional de Sobradinho, Secretaria de Estado da Saúde do Distrito FederalBrasíliaBrazil
  6. 6.SMHN Q 2 Bl A Ed Clinicas salas 804-806BrasíliaBrazil

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