Chest wall deformities

Abstract

Chest wall deformities can be grouped into depression deformity (pectus excavatum) and protrusion deformity (pectus carinatum), which comprise the overwhelming majority of patients, and a variety of rare anomalies including sternal cleft, Poland's syndrome, and complex chest cage malformations, such as Jeune's syndrome. Clinical evaluation should include careful interrogation of symptoms, anatomic definition by radiographic means, and objective testing tailored to the morphology; in patients with cardiac or pulmonary compromise from mechanical sources, EKG, echocardiogram and pulmonary function testing. Since the advent of the Nuss procedure, there has been a sea of change in management; for both excavatum and carinatum, resection can often be replaced by nonsurgical correction or operations which do not require cartilage resection. The rare abnormalities should be managed with careful review of current experience: management can be challenging, and consideration should be given to regionalization of care.