대한흉부영상의학회 Weekly Chest Cases

Case No : 304 Date 2003-08-23

Courtesy of Kyung-Hyun Do, M.D., Jae-Woo Song, M.D. / Asan Medical Center, Seoul, Korea
Age/Sex 15 / M
Chief ComplaintFor pre-operative evaluation

Figure 1

Diagnosis With Brief Discussion

Diagnosis: Funnel Chest (Pectus Excavatum)
Radiologic Findings: On chest PA, the heart shifts to the left and right cardiac border is obscured. The ribs are asymmetrical and right ribs run vertically. Sternal depression is easily identified on lateral projection. Chest CT shows deformity of the thoracic cage.
Brief Review: This common deformity consists of depression of the sternum so that the ribs on each side protrudes farther anteriorly than the sternum itself. It is frequently associated with other congenital connective tissue disorders, such as Marfan's syndrome, Poland's syndrome, scoliosis, and Pierre Robin syndrome.
The roentgenographic manifestations are easily recognized. In posteroanterior projection, the heart usually shifts to the left, its left border is straightened, and the pulmonary arc is prominent because of slight cardiac rotation toward the right oblique. Increased transverse diameter and a subtle central radiolucency of the heart may be present, attributable to the thinner anteroposterior diameter secondary to intrusion by the unusual clarity of the spine and of the right cardiophrenic vasculature. The parasternal soft tissues of the anterior chest wall, which are seen in profile rather than en face, are apparent as increased density over the inferomedial portion of the right hemithorax and should not be mistaken for disease of the right middle lobe, even though the right heart border is obscured by a silhouetting effect. The ribs are often asymmetrical and take an abnormal course. The degree of sternal depression is easily seen on lateral roentgenogram.
The vast majority of patients with pectus excavatum are symptom-free, except possibly for the anxiety occasioned by the physical deformity. However, cardiac and respiratory symptoms occasionally have been attributed to the abnormality. A heart murmur is also fairly common, often simulating pulmonic stenosis and probably resulting from kinking of the pulmonary artery.
References: 1. Fraser RS et al. Synopsis of diseases of the chest. 2nd edition 1994 Philadelphia: W.B. sounders company 956~957.
2. Felson B. Chest roentgenology. 1973 Philadelphia: W.B. sounders company 459.
Keywords: Chest wall, Congenital,

No. of Applicants : 36

▶ Correct Answer : 23/36, 63.9%

- Annecy Hospital, France Gilles Genin
- Asan Medical Center, Korea Eun Jin Chae
- Calmette Hospital, Lille, France Philippe Dumont
- Chonnam National University Hospital, Korea Jin Woong Kim
- Chonnam National University Hospital, Korea Seul-Kee Kim
- Chonnam National University Hospital, Korea In Kyoung Lee
- Chonnam National University Hospital, Korea Yong-Joo Moon
- CHU Nancy-Brabois, France Denis Regent
- Chungju Hospital Konkuk University, Korea Chang Hee Lee
- CIM Saint Dizier, France JC Leclerc
- EPM-UNIFESP and Fleury MC, Sao Paulo, Brazil Gustavo Meirelles
- IMSL, Metz, France Eric Gaconnet
- Inha University Hospital, Korea Dong-Jae Shim
- Jeonju Samsung Hospital Kyung-Hee Noh
- Kyunghee University Hospital Kyung Ran Ko
- MD anderson cancer center, TX, USA Jeong-Geun Yi
- Ohio State University, Ohio, USA Sumit Seth
- Pusan National University Hospital, Pusan, Korea Hye-Jeung Choo
- Seoul National University Hospital, Korea Jung-Gi Im
- Shinmasan Hospital, Korea Kyung Hwa Jung
- St Stephen's Hospital, Tis Hazari, Delhi, India Jasdev S Sawhney
- Upasana Hospital, Kollam, India Joy A Thomas
- Xray Clinic, Pune, India Anand Rahalkar

▶ Semi-Correct Answer : 2/36, 5.6%

- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- MH(CTC), Pune, India Vivek Sharma

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 304 Date 2003-08-23

Discussion

No. of Applicants : 36