Diagnosis Of Pectus Excavatum Research Articles

Peer Mentorship Enhances Coping in Children, Adolescents, and Young Adults with Pectus Excavatum and Adolescent Idiopathic Scoliosis

Purpose: Children and adolescents and young adults (AYA) with pectus excavatum (PE) and adolescent idiopathic scoliosis (AIS) experience similar journeys regarding pain, body image, and self- and peer acceptance. Peer mentoring may address some of the challenges faced regarding diagnosis and treatment of PE and AIS. Before implementing a mentor program, our hospital noted an increased length of stay (LOS) and difficulty coping in those undergoing surgery for PE and AIS, emphasizing the need for additional support. The purpose of this study was to evaluate the impact of a peer mentor program for children/AYAs with PE or AIS and their parents on coping, pain, and LOS. Design and Methods: This non-randomized controlled trial included a prospective intervention group that received peer mentorship and a retrospective control group that received standard care. Self-reported surveys assessed the effect of the mentor program on coping. Qualitative data on coping were analyzed descriptively. Postoperative pain and LOS were obtained from the health record. Bivariate inferential statistics were used to compare the distribution of pain scores and LOS between intervention and control groups. Results: Children/AYAs, parents, and mentors reported enhanced coping and found peer mentorship beneficial, though it did not have a statistically significant impact on pain or LOS. Conclusions: Peer mentorship facilitates coping in children/AYAs with PE or AIS undergoing corrective surgery. Parents and mentors also perceived benefits. Practice Implications: Pediatric nurses and child life specialists can help children/AYAs, and their families prepare for surgery by connecting them with peer mentors and social support.

Automatic contour correction of pectus excavatum using computer-aided diagnosis and convolutional neural network

Pectus excavatum (PE) is a common congenital sternal malformation disease that significantly impacts the physical and psychological well-being of affected individuals. Traditional methods for diagnosing and correcting PE rely heavily on physician expertise, leading to potential uncertainties and errors. While current research has primarily focused on automatic indices extraction and deformity evaluation, there is a lack of emphasis on generating corrective solutions for patients with PE. To address these limitations, we present a novel convolutional neural network (CNN)-based computer-aided diagnosis (CAD) approach for automatically generating recommended corrections for patients with PE. Specifically, our approach involves training a CNN model using sternum contours from normal individuals to predict corrected sternum contours for patients. Through block-wise fine-tuning using transfer learning, we optimize the regression performance for three PE indices. The complete contours of patients are then depicted based on the predicted indices using our CAD method. To validate our approach, we collected a dataset comprising 11,755 chest CT images from 40 PE patients and 40 healthy individuals. The results suggest there is no significant difference between the predicted contours generated by our model and the actual postoperative contours by skilled surgeons, underscoring the promising efficacy of our model. In summary, our novel approach goes beyond the limitations of existing techniques and offers a significant advancement in the diagnosis and correction of PE.

Diverse clinical presentation of primary spontaneous pneumothorax in patients with pectus excavatum.

Patients with primary spontaneous pneumothorax (PSP) tend to be young, tall, and thin, as do those with pectus excavatum (PE). Notably, the Haller index, which measures the severity of PE, tends also to be higher in patients with PSP, further suggesting a potential predisposing factor for the development of PSP in individuals with PE. This study aimed to share clinical experiences with case series of concomitant PSP and PE and to emphasize the importance of evaluating these two conditions together. In this single-center study, we conducted a retrospective records review to identify patients who were diagnosed and treated (including surgical or conservative treatment and follow-up observation) for the diagnosis of PE between July 2011 and February 2023. From these, we selected patients who were diagnosed with both PE and PSP and analyzed their clinical presentations. Among a total of 139 patients with PE, there were 8 (5.76%) who had concurrent diagnoses of PE and PSP and who underwent surgery for PSP, PE, or both. The average age of these 8 patients (male:female = 7:1) was 19.38 years. The 8 patients were grouped into four categories based on their clinical scenarios. Group A had 1 patient with PE diagnosed first, followed by the discovery of PSP during evaluation; Group B included 2 patients initially presenting with PSP and subsequently diagnosed with PE during evaluation; Group C consisted of 1 patient who had PSP before undergoing surgical PE correction; and Group D comprised 4 patients who developed PSP after PE correction. The incidence of PSP in patients with PE was 5.76% (8 out of 139 patients), indicating the importance of vigilant monitoring for PSP prior to PE surgery, and vice versa. Furthermore, the authors recommend close observation for PSP independent of PE surgery, even in the absence of postoperative complications.

Preventing bar-related complications for chest wall deformities

Aim: Nuss procedure for pectus excavatum and Abramson procedure for pectus carinatum are used as minimally invasive methods for surgical treatment of chest wall defomities. The aim of this study is to investigate the causes of bar-related complications, and to present technical details of their management. Materials and Methods: Patients who underwent minimally invasive correction surgery with the diagnosis of pectus excavatum and pectus carinatum between 2011-2020 in our clinic were included in this study. The surgical treatments, bar related complications, and follow-up records of patients were recorded and analyzed retrospectively. Results: 141 patients with a mean age of 16.08 ± 4.38 were included in the study. Postoperative bar-related complications were encountered in 28 (19.8%) of all patients. There were no life-threatening early or late complications. The most common complication was skin reaction in 7 (4.9%) cases. Conclusion: Bar-related complications are problems that can cause morbidity and disrupt patient comfort, thus management of complications should be focused on.

Cardiovascular MRI assessment of pectus excavatum in pediatric patients and postoperative simulation using vacuum bell

BackgroundThe sternal lift by Vacuum Bell (VB) is effective, as largely demonstrated by its intraoperative use during surgical procedure to elevate the sternum during the Nuss procedure routinely. Indeed, the thoracic remodelling during VB application is comparable to post-surgical scenario, and suitable to compare cardiovascular parameters of the two different thoracic configurations immediately. ObjectiveWe would quantify and correlate preoperative parameters which determine the severity of the pectus excavatum (PE), and the cardiovascular effects at the baseline. Than we would assess the cardiovascular changes during VB positioning, mimicking the immediate, temporary effect of Pectus-correction. Materials and MethodsWe included 26 consecutive patients (mean age is 13,3 +/- 2,2 years) symptomatic and non, with a previous clinical diagnosis of PE. CMR was performed before and during application of VB, using the same imaging protocol. In both conditions, we measured thoracic indexes, and cardiac function as well as flow through main vessels. ResultsMean expiratory Haller Index (HI) was 5,4 (+/-1,4 SD; normal <3). During VB application, all patients showed improvement in the main morphologic parameters of the thorax (mean expiratory HI = 4,7 (+/-1,6 SD, delta -13%, P = 0,01). During VB application, a minimal but not significant increase of Right Ventricle End Diastolic Volume (RVEDVi) (delta +4,6%, P = 0,12), and Right Ventricle Ejection Fraction (RVEF) (delta +1,2%, P = 0,2) was observed. ConclusionIn adolescents affected by PE, cardiacMRI (CMR) demonstrates normal values of biventricular volume and systolic function. During VB application, beside significative improvements in chest wall anatomy, CMR shows a minimal positive variation in right ventricle volume and function. A minority of patients showed some degree of diastolic dysfunction at baseline, unchanged after VB application, with possible correlation between valve inflow and sternal impingement.

Computer-aided diagnosis of pectus excavatum using CT images and deep learning methods

Pectus excavatum (PE) is one of the most common chest wall defects. Accurate assessment of PE deformities is critical for effective surgical intervention. Index-based evaluations have become the standard for objectively estimating PE, however, these indexes cannot represent the whole information of chest CT images and may associated with significant error due to the individual differences. To overcome these limitations, this paper developed a computer-aided diagnosis (CAD) system based on the convolutional neural network (CNN) to automatically learn discriminative features and classify PE images. We also adopted block-wise fine-tuning methods based on the transfer learning strategy to reduce the potential risk of overfitting caused by limited data and experimentally explored the best fine-tuning degree. Our method achieved a high level of classification accuracy with 94.76% for PE diagnosis. Furthermore, we proposed a majority rule-based voting method to provide a comprehensively diagnostic results for each patient, which integrated the classification results of the whole thorax. The promising results support the feasibility of our proposed CNN-based CAD system for automatic PE diagnosis, which paves a way for comprehensive assessments of PE in clinics.

A different application of nuss procedure in a difficult case of pectus excavatum

A 17 year-old male patient who had a history of Nuss procedure 8 months ago with a diagnosis of pectus excavatum, the bar had been removed with left anterior thoracotomy due to complications such as bar dislocation, hemothorax and infection. Minimally invasive reoperation was performed on the patient who had an asymmetrical collapse distinctive on the right side. Classical Nuss operation was not possible due to strong adhesions that developed after past procedures. At this point, instead of open surgery, we entered the thoracic cavity with two new incisions performed on the two peak points of the collapse. A tunnel was formed beneath the sternum with obtuse and sharp opposing dissections through the newly formed holes. Subsequently, subcutaneous tunnels were opened up to the new entry holes through the initial incisions that were formed left and right previously. The bar was swiped under the sternum and rotated by using the subsequent holes as entry and exit holes for the bar. It was immobilized with a stabilizer. No complications occurred in the postoperative period. Pleural adhesions are accepted as one of the most important contraindications of thoracoscopic surgery. Nevertheless, with the help of two incisions in addition to the main procedure we present our case of re-operated pectus excavatum with a minimally invasive procedure and a successful outcome.

Exaggerated Interventricular Dependence Among Patients With Pectus Excavatum: Combined Assessment With Cardiac MRI and Chest CT.

We sought to explore whether patients with pectus excavatum have exaggerated interventricular dependence and to evaluate the impact of the malformation severity (assessed on CT) on both anatomic and functional cardiac parameters (assessed on cardiac MRI). The current study involved consecutive patients with a diagnosis of pectus excavatum who were referred to undergo cardiac MRI and chest CT to establish surgical candidacy or to define treatment strategies. Sixty-two patients with pectus excavatum underwent cardiac MRI and chest CT. Fifty (81%) patients were male, and the median age was 17.5 years (range, 14.0-23.0 years). Forty-seven (76%) patients had evidence of right ventricular compression. The left ventricle showed a significantly decreased end-diastolic volume (inspiration vs expiration: 70.4 ± 11.6 vs 76.1 ± 13.7 mL/m2, respectively; p = 0.01) and a significantly higher eccentricity index (1.52 ± 0.2 vs 1.20 ± 0.1, p < 0.0001) during inspiration than during expiration. The median respiratory-related septal excursion was 8.1% (interquartile range, 5.1-11.7%). Patients with pericardial effusion showed a significantly higher pectus excavatum severity index than patients without pericardial effusion (6.3 ± 3.4 vs 4.4 ± 1.3, respectively; p = 0.003). Patients with a relative septal excursion equal to or larger than 11.8% showed a significantly higher pectus excavatum severity index than patients with a relative septal excursion of less than 11.8% (6.3 ± 2.6 vs 4.7 ± 2.4, respectively; p = 0.05). In this study, patients with pectus excavatum showed significant alterations of cardiac morphology and function that were related to the deformation severity and that manifest as an exaggerated interventricular dependence.

Mr. Shyam Kolvekar’s view regarding the diagnosis of pectus excavatum (PE)—with special consideration on psychological impact

Mr. Shyam Kolvekar’s view regarding the diagnosis of pectus excavatum (PE)—with special consideration on psychological impact

Pectus Excavatum and Pectus Carinatum: Associated Conditions, Family History, and Postoperative Patient Satisfaction.

BackgroundPectus excavatum (PE) and pectus carinatum (PC) are the most common chest wall deformities. In this study, we aimed to characterize how patients obtained information about these deformities, as well as patients’ family history, associated medical problems, and postoperative satisfaction after the Nuss and Abramson procedures.MethodsThis cross-sectional retrospective study included patients who were operated by a single surgeon between 2006 and 2013. Follow-up calls were made after approval of our institution’s ethics committee. We reached 207 of the 336 PE patients (61.6%) and 73 of the 96 PC patients (76%).ResultsThe majority of the patients were male (85% of the PE patients and 91.8% of the PC patients). The age of diagnosis of PE was 14.52±0.51 years and the age at the time of operation was 17.89±0.42 years; for PC patients, the corresponding ages were 15.23±0.55 years and 16.77±0.55 years, respectively. A total of 70% of the PE patients and 63.8% of the PC patients obtained information about pectus deformities through the Internet. In 27.1% of the PE patients with an associated anomaly, 57.1% (n=13) had scoliosis, while 41.1% of the PC patients with an associated anomaly had kyphosis (n=5). Postoperative satisfaction, as evaluated on a scale from 0 to 10, was 8.17±0.15 for PE patients and 8.37±0.26 for PC patients. The postoperative pain duration was 51.93±5.18 days for PE patients and 38.5±6.88 days for PC patients.ConclusionIn this study, we found that most patients with pectus deformities were male. The Internet was an important resource for patients to learn about their deformities. Family history and associated anomalies were identified as important aspects for consideration in the clinical setting. The patients reported high levels of postoperative satisfaction, and pain management was found to be one of the most important elements of postoperative care.

Correction of Pectus Excavatum With Breast Hypoplasia Using Simultaneous Pectus Bar Procedure and Augmentation Mammoplasty

Most women with asymmetric pectus excavatum suffer from hypoplastic breasts. Hence, aesthetic correction of pectus excavatum has to address thoracic wall deformity, breast hypoplasia, and asymmetry.In retrospective series, 21 patients with a diagnosis of pectus excavatum with hypoplastic breasts were corrected using the pectus bar procedure and subpectoral augmentation mammoplasty. Results were assessed by analyzing prospectively collected data and calculating pectus indices from computed tomographic scans. At 12 months postoperatively, cosmetic evaluations were performed by the patients and by an independent, board-certified plastic surgeon using score from 0 (very poor) to 4 (very good).Cosmetic results evaluated by plastic surgeon were good (3.33 ± 0.03) and patient satisfaction was high (3.52 ± 0.03). Furthermore, indices of pectus excavatum were corrected to near normal.The authors consider that the pectus bar procedure with subpectoral augmentation mammoplasty is useful for the aesthetic correction of pectus excavatum with hypoplastic breasts.

Correlations of Adolescent Idiopathic Scoliosis and Pectus Excavatum

Radiologic study of scoliosis in pectus excavatum patients. To determine the relation between pectus excavatum deformity and adolescent idiopathic scoliosis (AIS). AIS may be related to other whole body deformities, but few reports have addressed the relation between chest deformity and scoliosis. A total of 248 patients with a diagnosis of pectus excavatum were enrolled in this study. All study patients underwent whole spine anteroposterior radiographs and chest computed tomography. Severity and type of scoliosis and chest deformity were measured using radiographs, and relations between pectus deformity and AIS were analyzed. Overall, 56 of the 248 study patients had scoliosis (Cobb angle > 10 degrees)--a prevalence of 22.58%. The incidence of scoliosis was significantly higher in female patients (38.46%) (P = 0.002), and Lenke type 1 predominated in pectus patients (48.2%, P < 0.0001). Mean age was greater in the scoliosis group than in the nonscoliosis group (P < 0.0001), and the asymmetry of pectus deformity was more prominent in the scoliosis group (P = 0.007). However, pectus deformity severity was similar in the 2 groups (P = 0.061). Furthermore, although the scoliosis group showed a higher proportion of female patients (P = 0.002), the severities of chest and spinal deformities were similar in the 2 groups for both sexes (P = 0.314, P = 0.227). Pectus excavatum and AIS were found to have a high concomitant incidence. And, the age, sex, and type of disease were significantly different in the scoliosis and pectus excavatum groups. Surgeons should consider these relationships when deciding upon treatment in patients with chest and spinal deformities.

Use of internal splinting to realign a noncompliant sternum in a cat with pectus excavatum

A 5.5-month-old female domestic longhair cat was examined because of dorsal deviation of the caudal aspect of the sternum and progressively worsening dyspnea during play activities. A diagnosis of pectus excavatum was made clinically and confirmed radiographically. The cardiac silhouette was shifted into the right hemithorax. The vertebral index (VI) and frontosagittal index (FSI), which are radiographic indices used to grade the extent of the deformity, were 5.2 and 3.0, respectively. Minimum thoracic height was 13 mm at this time. The sternal malposition was corrected during surgery; for stabilization, an internal splint was provided by use of a plate that was applied to the ventral side of the sternum. Radiographic indices improved until day 85; at that time, an increase in the distance between plate and sternum was detected, and plate removal was advised. The radiographic indices improved again after plate removal. At 310 days after surgery, VI was 9.6, FSI was 1.6, and minimum thoracic height was 34 mm. No dyspnea was evident during physical examination. Results of treatment suggest that this technique may be useful as an alternative surgical option for cats with pectus excavatum that have a noncompliant sternum.

Pectus excavatum: Late results with and without operation

The records were reviewed of 334 patients with a diagnosis of pectus excavatum at Presbyterian Hospital in New York, New York, from 1948 through 1977. No operation was done on 168; 174 operations were done on 166. In those not operated upon 18% of infants died of associated anomalies. The deformity improved or disappeared in half of the surviving infants and in some children up to the age of 6 years. Thereafter, it remained the same or worsened. Mild deformities were compatible with long life without symptoms; severe deformities were associated with chronic disability. In those operated upon, there was no surgical mortality. Results were satisfactory 5 plus years after operation in 68 of 102 patients. Late results deteriorated through adolescence and were more clearly related to method of correction than to sex, severity, age at operation, or time after operation. It is concluded that (1) operation is justified in appropriate cases; (2) it is seldom indicated before the age of 3 years; (3) results are best following operations between ages 3 and 6 years, although they may be satisfactory at any age; (4) results of radical operations are superior to results of simpler ones; and (5) better objective methods of evaluation over many years are needed to judge the value of any procedure.