CHEST DEFORMITIES

1. PECTUS EXCAVATUM (FUNNEL CHEST)

- Pectus excavatum (PE) is an abnormal development of the rib cage where the breastbone (sternum) caves in, resulting in a sunken chest wall deformity.

ETIOLOGY- overgrowth of coastal cartilage, abnormalities of diaphragm, rickets, raised intra uterine pressure, childhood asthma, marfans syndrome.

CLINICAL PRESENTATION- progressive, depth increases with age, M:F-6:1, produces pain after vigorous exercise, palpitations, flow murmur because of close proximity. Measurement of severity- transverse/AP diameter in CT scans,( >3.25- severe require surgery.)

2. PECTUS CARINATUM - A spectrum of deformities that involve the coctochondral cartilage and sternum, two common types-

chondrogladiolar and chondromanubrial.

ETIOLOGY -Charecterised by overgrowth of costochondral cartilage, associated with scoliosis, congenital heart diseases, marfans and other connective tissue disorders.

CINICAL PRESENTATION Fixed AP diameter results in increased residual volume exetional brethlessness, exercise indused asthma. HARRISON’S SULCUS- It is due to the indrawing of the ribs to form symmetrical horizantal grooves above the coastal margin along the line of attatchment of diaphragm.

3. POLAND SYNDROME – rare birt defect charecterised by underdevelopment or absence of the chest muscle

(pectoralis) on one side of the body wich may be associated with cutaneous syndactyly of the ipsilateral hand. M:F – 3:1, R:L – 3:1. Treatment includes chest wall reconstruction in patients with rib aplasia with autologous rib grafting.

4. JEUNE SYNDROME (asphyxiating thorasicdystrophy)- is a failure of chest wall growth inutero resulting in

narrow chest cavity and pulmonary hypoplasia, autosomal recessive inheritance, treatment inclues lateral thorasic expansion.

5. STERNAL DEFECTS - seen in turners syndrome and trisomy 18. Four types a. thorasic ectopia cordis b.

Cervical ectopia cordis c. Thoracoabdominal ectopia cordis d.cleft sternum.

6. KYPHOSIS - also called hunchback, is a common condition of a curvature of the upper spine. It can be

either the result of degenerative diseases (such as arthritis), developmental problems, osteoporosis with compression fractures of the vertebrae, and/or trauma. 1. Postural kyphosis – physiological in infants and eldery, pathologial in vertebral fractures, reversible by

fixing the fractures and treating muscular imbalance.2. Scheuermanns kyphosis- juvenile osteochondrosis.3. Congenital kyphosis.4. Nutritional kyphosis- vit D deficiency.

7. SCOLIOSIS - is a medical condition in which a person's spine is curved from side to side.

1. Idiopathic scoliosis- classifed into infantile, juvenile, adolescent idiopathic scoliosis, more than 80% are idiopathic.

2. Congenital scoliosis.3. Neuromuscular scoliosis-children with cerebral palsy, spina bifida, or muscular dystrophy-can

develop neuromuscular scoliosis.i

4. Adult or degenerative scoliosis- Osteoporosis, disc degeneration, spinal compression fracture. A cobb angle of 10* is considered as the minimal angle to define scoliosis

i References : Online med, Alagappan, Mcleod, Cleveland clinic.