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Treatment of pectus excavatum in Jordan

Congenital pectus excavatum

Pectus Excavatum
The most common chest wall deformity is concavity of the rib cage or sunken thorax and is caused by an abnormal growth at the junction of the costal cartilage between the ribs and the sternum. It can appear in young children but usually appears during the growth spurt and puberty.



  • Chest and back pain is common.

  •   Another common complaint is the feeling of shortness of breath, especially on exertion.

  • The psychological impact of abnormal chest appearance is perhaps the most important symptom that patients with pectus excavatum complain of. In some cases, it can have severe consequences that lead to withdrawal behaviour, avoiding certain activities such as swimming, exercise, depression, anxiety, and societal anxiety are all consequences of untreated pectus excavatum.

  • Heart palpitations - with a heart malformation, there may be an increased incidence of heart palpitations.

  • Syncope - classically during exercise and thought to be due to cardiac malformation of the inner sternum.



Most clinicians recognize a clear association between the sunken appearance of the chest and decreased lung function as well as the physical displacement of the heart that causes symptoms such as shortness of breath. However, when lung or lung function is measured on simple tests (measurement of lung efficiency), they appear normal in most patients with pectus excavatum. But when measured with more sophisticated examinations and tests (cardiopulmonary exercise tests), studies have shown a relationship between shortness of breath on exertion and decreased pulmonary reserve.

In cases of pectus excavatum, the sternum is pushed back and the heart sitting behind the sternum may shift slightly to the left and may affect heart function. Some studies have found that surgery to correct pectus excavatum can improve heart function when carefully measured.



Diagnosing thoracic concavity is what doctors call a clinical diagnosis, and usually all that is required is a thorough physical examination with a physician familiar with chest abnormalities. There is no specific blood test, but a radiological evaluation (X-ray) may help assess the severity of pectus excavatum and identify other associated problems such as scoliosis of the spine. The most useful radiological examination is the CT scan of the chest which allows a more sensitive assessment of the concavity of the chest especially its severity and cardiac displacement, as well as the degree of shear rotation caused by chest asymmetry.

There are other tests such as echocardiography (ultrasound evaluation of the heart) and pulmonary function testing when severe symptoms and/or an underlying cause such as Marfan syndrome are present.


concavity intensity

The simple clinical description of the severity of the concavity of the chest depends on the depth of pushing the sternum inward.

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