Cardiopulmonary Manifestations of Pectus Excavatum

Michael K. Cheezum, MD; Christopher J. Lettieri, MD


April 10, 2008

In This Article

Diagnosis and Measures of Severity

The diagnosis of pectus excavatum can be made by simple observation or recognition of an inward displacement of the sternum and anterior chest wall. Radiographic imaging can identify more subtle cases and is useful in determining the severity of disease and compression of underlying thoracic structures.

Chest x-ray can be helpful not only in the recognition of this abnormality but also in identification of associated intrathoracic pathology, such as displacement of the mediastinal structures, kyphoscoliosis, and bronchiectasis. Rotation and asymmetry of the sternum should be measured. Although the deformity can be identified on physical exam or on lateral chest x-ray, computed tomography of the chest is often needed to determine the severity of the deformity.

Several indices are used to grade severity, but the Haller index, or pectus severity index, is a well-established and commonly referenced scale.[8] The Haller index is derived by dividing the transverse diameter of the chest by the anteriorposterior diameter, measured from the inner aspect of the sternum to the anterior aspect of the vertebral body (Figure 1). An index greater than 2.5 is considered significant and an index greater than 3.2 is considered severe and is often used as a criterion for surgical candidacy.[9] Rotation, asymmetry, and underlying chest morphology (ie, barrel chest vs flat chest) may confound this measurement.

CT scan demonstrating Haller Index calculation (Haller index = transverse diameter/anteroposterior diameter). Note the leftward displacement of the heart secondary to the pectus deformity.


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