Hemidystrophic Thorax Mimicking Scoliosis.

Hans-Rudolf Weiss,Sarah Seibel

doi:10.2174/1874325001812010252

Abstract

Background:We regularly use Angle of Trunk Rotation (ATR) measurements for scoliosis screening and also for clinical follow-up of our scoliosis patients under treatment. In some patients, when ATR measurements exceed the screening threshold but without a significant degree of curvature on the X-ray (Cobb angle), a Hemidystrophic Thorax (HDT) is diagnosed. The purpose of this paper was to present a case series of patients with this kind of thoracic deformity because this may be mimicking scoliosis to a significant degree.Materials and Methods:This case series is a consecutive series of patients where the first author detected a hemidystrophic thorax instead of or in combination with scoliosis. A 3D scan of the trunk was made and adjusted to the coordinates in order to achieve an upright orientation of the upper trunk. The scan was scaled in order to determine certain anatomic landmarks, as performed in preparation for bracing. The scan was cut horizontally at the xiphoid level and the plane at this level was analysed visually in order to detect deformations that were different to the typical scoliotic deformations in the horizontal plane.Results:Seven cases were analysed and described in more detail.Conclusion:The condition of HDT may lead to significant rib humps that mimic scoliosis. According to our case series, mild scoliosis can also be associated with HDT. HDT, according to the cases presented in this study, seems to be a relatively benign deformity. Long-term observations are necessary before a final conclusion can be drawn with respect to prognosis.

Highlights

IntroductionPectus Excavatum (PE) is the most common congenital chest wall deformity, accounting for over 90% of all chest wall deformities [2]
Pectus Excavatum (PE), Pectus Carinatum (PC), Poland Syndrome (PS), Sunken Chest Deformity (SCD), Barrel Chest Deformity (BCD), Body Builder Deformity (BBD), and Long Upper Chest Wall (LCW) are Chest Wall Deformities (CWDs) that are documented in the literature [1].PE is the most common congenital chest wall deformity, accounting for over 90% of all chest wall deformities [2]
We have found in some patients Angle of Trunk Rotation (ATR) measurements that exceed the screening threshold but without a significant degree of curvature on the X-ray (Cobb angle)

Summary

Introduction

PE is the most common congenital chest wall deformity, accounting for over 90% of all chest wall deformities [2]. The second most common deformity of the anterior chest wall is PC, called pigeon chest. It is a diverse deformity and may be symmetric or asymmetric [4]. We regularly use Angle of Trunk Rotation (ATR) measurements for scoliosis screening and for clinical follow-up of our scoliosis patients under treatment. In some patients, when ATR measurements exceed the screening threshold but without a significant degree of curvature on the X-ray (Cobb angle), a Hemidystrophic Thorax (HDT) is diagnosed. The purpose of this paper was to present a case series of patients with this kind of thoracic deformity because this may be mimicking scoliosis to a significant degree

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Discussion

Conclusion