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Classification of the dysmorphology of pectus excavatum

  • Mark J. Cartoski
    Affiliations
    Department of Surgery, Eastern Virginia Medical School and Children's Hospital of The King's Daughters, Norfolk, VA 23507, USA
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  • Donald Nuss
    Affiliations
    Department of Surgery, Eastern Virginia Medical School and Children's Hospital of The King's Daughters, Norfolk, VA 23507, USA

    Department of Pediatrics, Eastern Virginia Medical School and Children's Hospital of The King's Daughters, Norfolk, VA 23507, USA
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  • Michael J. Goretsky
    Affiliations
    Department of Surgery, Eastern Virginia Medical School and Children's Hospital of The King's Daughters, Norfolk, VA 23507, USA

    Department of Pediatrics, Eastern Virginia Medical School and Children's Hospital of The King's Daughters, Norfolk, VA 23507, USA
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  • Virginia K. Proud
    Affiliations
    Department of Pediatrics, Eastern Virginia Medical School and Children's Hospital of The King's Daughters, Norfolk, VA 23507, USA
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  • Daniel P. Croitoru
    Affiliations
    Department of Surgery, Eastern Virginia Medical School and Children's Hospital of The King's Daughters, Norfolk, VA 23507, USA

    Department of Pediatrics, Eastern Virginia Medical School and Children's Hospital of The King's Daughters, Norfolk, VA 23507, USA
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  • Tina Gustin
    Affiliations
    Department of Surgery, Eastern Virginia Medical School and Children's Hospital of The King's Daughters, Norfolk, VA 23507, USA
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  • Karen Mitchell
    Affiliations
    Department of Surgery, Eastern Virginia Medical School and Children's Hospital of The King's Daughters, Norfolk, VA 23507, USA

    Department of Pediatrics, Eastern Virginia Medical School and Children's Hospital of The King's Daughters, Norfolk, VA 23507, USA
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  • Ellen Vasser
    Affiliations
    Department of Pediatrics, Eastern Virginia Medical School and Children's Hospital of The King's Daughters, Norfolk, VA 23507, USA
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  • Robert E. Kelly Jr.
    Correspondence
    Corresponding author. Children's Hospital of the King's Daughters, 601 Children's Lane, Norfolk, VA 23507, USA.
    Affiliations
    Department of Surgery, Eastern Virginia Medical School and Children's Hospital of The King's Daughters, Norfolk, VA 23507, USA

    Department of Pediatrics, Eastern Virginia Medical School and Children's Hospital of The King's Daughters, Norfolk, VA 23507, USA
    Search for articles by this author

      Abstract

      Background/Purpose

      To describe the dysmorphology of pectus excavatum, the most common congenital chest wall anomaly.

      Methods

      A stratified sample of 64 patients, representative of a patient population with pectus excavatum of the Children's Hospital of King's Daughters in Norfolk, Va, was described and classified. The sample was stratified by sex to represent a 4:1 male-to-female ratio. The sample was further stratified to represent categories of age (3-10, 11-16, and 17 years and older). Preoperative photos and baseline chest computed tomography scans were examined and categorized according to the chief criteria, including asymmetry/symmetry of the depression, localized vs diffuse morphology, sternal torsion, cause of asymmetric appearance, and the length of the depression.

      Results

      Useful morphologic distinctions in pectus excavatum are localized depressions vs diffuse depressions, short and long length, symmetry, sternal torsion, slope/position of absolute depth, and unique patterns such as the horns of steer depression.

      Conclusions

      These classifications simplify the diagnosis of pectus excavatum, aid in corrective surgery, and should improve correlation of phenotype and genotype in future genetic analysis.

      Index words

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