0 The most common is depression (Pectus excavatum) or protrusion (Pectus carinatum) of the anterior wall.
0 The second most common is failure of normal development (aplasia/dysplasia).
0 It is frequently associated with connective tissue diseases (Marfan Syndrome, Ehler's Danlos Syndrome)
0 Scoliosis accompanies these patients in 20%.
0 Surgery is rarely necessary, except for life-incompatible ectopiccordis and Cantrell's pentalogy: Those five defects are of the heart, pericardium, diaphragm, sternum, and abdominal wall.
Pectus Excavatum
0 Severe cases have cardiac compression and pulmonary constriction causing dyspnea with exertion, tolerance to exercise, and chest pain.
0 The most common symptom is exertional dyspnea. Then, respectively, are chest pain and loss of diaphragmatic strength.
0 Symptoms are more pronounced in older children because their chest wall is more rigid.
0 On physical examination, there is pectus posture (thoracic kyphosis, forward-bending shoulder, protruding abdomen).
0 Deformity can be diffuse (cup-shape), eccentric (saucer-shape) and mixed type.
0 Cardiac pressure; It can cause a decrease in cardiac output, impaired valve functions and arrhythmias.
0 Lung effects; restrictive lung disease, atelectasis, and paradoxical breathing.
0 There are surgical criteria according to heart and lung findings and the ideal surgical time is the prepubertal period.
Pectus Carinatum
0 It is less common and is 4 times more common in Males.
0 Unlike excavatum, it occurs in late childhood and progresses rapidly.
0 There is no pulmonary or cardiac pressure.
0 Treatment is pressure ligament or surgery.
Poland's Syndrome
@ The jeans are characterized by the absence of pectoralis major and minor, serratus anterior, rectus abdominis, and lattisimus dorsi muscles.
@ The chest may not be (amastia), there are nipple deformities.
@ Syndactyly may be accompanied by extremity deformities such as brachydactyly.
@ Absence of axillary hairs and limited subcutaneous adipose tissue.
@ It is often one-sided.
@ If the rib defects cause lung hernia, surgery is applied.
Sternal Slits
@ It can range from partial cleft to total deficiency causing ectopia cordis.
@ Inferior clefts are often associated with other organ anomalies (Cantrell's pentology).
@ Complete clefts cause ectopia cordis.
Pneumothorax and Pneumomediastinum
@ It is more common in newborns. Most recover without symptoms.
@ It is especially common in infants with fetal distress, birth trauma, lung hypoplasia and diaphragmatic hernia. It is also seen after positive pressure ventilation and staphylococcal pneumonia.
@ Hypersonority and decreased lung sounds are seen on the side with pneumothorax.
@ In radiology; On the lesion side, collapsed lung is observed at the hilum. There is an increase in the gap between the ribs.
@ In pneumomediastinum, radiological examination reveals the air surrounding the heart, the air separating the thymus from the heart shadow. In the lateral graph; Air bubbles behind the sternum are important for diagnosis.
@ In the treatment of pneumothorax; Aspiration and chest tube should be inserted through the 2-3 intercostal space and closed underwater drainage should be performed.
@ If the pneumomediastinum does not drain on its own, it is drained.
Bronchogenic Cyst
@ Respiratory distress causes dysphagia.
@ In the radiograph; mass in the mediastinum and pushing in the tracheal air column are observed.
@ In cases with respiratory distress, chest radiography gives the most valuable findings in the differential diagnosis.