Deformities of the Anterior Chest Wall in Children

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THE pediatrician and the thoracic surgeon are not infrequently consulted by the parents of children with deformities of the anterior chest wall. The commonest of these deformities is the funnel chest or pectus excavatum, and less common is the opposite deformity, pigeon breast, or pectus carinatum. Both of these deformities are closely related, a fact that becomes apparent as one examines a large number of them.

Various combinations of the two abnormalities are encountered in which there are asymmetric deformities of the anterior chest wall, one side being displaced outward and the other side inward, so that in the anteroposterior diameter one hemithorax is distinctly larger than the other. The most obvious skeletal changes involve the sternum and the adjacent costal cartilages; however, there are other aspects to the problem which affect the shape of the entire thoracic cage, and which therefore preclude total surgical correction. Obviously if one half of the thoracic cage has a greater anteroposterior diameter than the other, this asymmetry reflects a different shape of the entire rib cage on each side, and nothing can be done to alter this. Similarly it is extremely common for persons with pectus excavatum deformities to have a greatly decreased anteroposterior thickness of the entire chest structure, and although the surgeon may be able to correct nicely the actual depression, little can be done to alter the basic shape of the chest. To generalize: the greater the deformity to the sternum and cartilages the greater is the associated distortion of . . .



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