Pediatric Surgery International

, Volume 36, Issue 3, pp 305–316 | Cite as

The costochondral length in patients with pectus excavatum is longer than that of the normal thorax

  • Satoshi KondoEmail author
  • Daisuke Takagi
  • Satoshi Osaga
  • Katsuhiro Okuda
  • Ryoichi Nakanishi
Original Article



Recently, several investigators reported that costal cartilage does not overgrow in pectus excavatum (PE). We wished to clarify whether costochondral length is longer in PE than the normal thorax and we tried to clarify the change of the shape of precordial concavity according to the growth in PE.


We evaluated 243 CT axial images of patients with PE and 246 CT axial images of patients without thoracic deformity. We divided the fifth costal cartilage into several lengths. We considered each part to be a straight line and calculated the length of the lines. We compared the approximate costochondral length between PE and normal thorax. We analyzed the distance between both anterior tips of fifth rib, and the ratio of the width and the depth of concavity to thoracic diameter in PE.


The costochondral length in patients with PE is highly likely to be longer than that of the normal thorax. The length of costal cartilage may be longer in asymmetric PE than symmetric PE. It may start in infantile period in PE that the thoracic shape turns into asymmetry from symmetry. The precordial concavity of PE may be shaped by overgrowth of both costal cartilages and ribs.


Pectus excavatum Costochondral overgrowth Approximate length CT axial image Symmetric Asymmetric 


Author contributions

The first draft of the manuscript was written by Satoshi Kondo and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The ethical committee of Nagoya City University Graduate School of Medical Science ethically approved this study (60-18-0106).

Supplementary material

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Supplementary file1 (XLSX 179 kb)
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Supplementary file2 (JPG 1987 kb)
383_2020_4622_MOESM3_ESM.pdf (48 kb)
Supplementary file3 (PDF 48 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Division of Pediatric SurgeryNagoya City University HospitalNagoyaJapan
  2. 2.Department of Oncology, Immunology and SurgeryNagoya City University Graduate SchoolNagoyaJapan
  3. 3.Clinical Research Management CenterNagoya City University HospitalNagoyaJapan

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