Abstract
Purpose
The cause of pectus excavatum has been hypothesized to be overgrowth of the costal
cartilage. According to this theory, the length of costal cartilages must be longer
in the side of deep depression in asymmetric patients. To challenge this hypothesis,
we measured the lengths of ribs and costal cartilages and investigated lateral differences.
Subjects and methods
Twenty-four adolescent and adult patients with asymmetric pectus excavatum (14-30
years of age) with no history of surgery were investigated in this study. The fifth
and sixth ribs and costal cartilages were individually traced to measure their full
lengths on 3-dimensional computed tomographic (CT) images. As an index of asymmetry,
sternal rotation angle was measured in the chest CT images. Patients with a 21° or
greater angle of sternal twist were designated as an asymmetric group and those with
an angle of smaller than 20° as a symmetric group. Lateral differences in the fifth
and sixth costal and costal cartilage lengths were compared between the groups.
Results
On comparison of the costal and costal cartilage lengths in the asymmetric group,
the right fifth ribs and costal cartilages were significantly shorter than the left
(P = .02 and .03, respectively), and right sixth ribs were also significantly shorter
than the left (P = .004), but right sixth costal cartilages were not (P = .31). In the symmetric group, the lengths of the left and right fifth ribs and
costal cartilages were showing no significant difference (P = .20 and P = .80, respectively), and those of the sixth ribs and costal cartilage were also
showing no significant difference (P = .97 and P = .64, respectively).
Discussion
The ribs and costal cartilages on the right side with severer depression were significantly
shorter or not different than those on the contralateral side. Based on these findings,
the theory of costal cartilage overgrowth is contradictory.
The etiology of asymmetric chest deformity should be reevaluated.
Key words
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Article info
Publication history
Accepted:
September 26,
2008
Received in revised form:
September 26,
2008
Received:
July 4,
2008
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
