Pectus carinatum

Pectus carinatum chicken breast or chest deformity is characterized by a protrusion of the sternum and ribs. Pectus excavatum is the opposite.
The condition occurs in three ways. The most common is postsurgical after open-heart surgery. Sometimes the sternum does not heal but remain flat protruzionat. The second most common cause for congenital defect is pectus carinatum. Infants breast shows a round and as you reach the age of 3 years sternum begins to develop outside the chest. The condition is more evident in pubertal boys 11-14 years. It may appear as a solitary congenital deformity or in combination with other genetic disorders or syndromes, Marfan syndrome, Morquio syndrome, Noonan syndrome, trisomy 18, 21, osteogenesis imperfecta. Approximately 25% of patients there is also a member of the family with this condition.
Those affected usually develop a normal heart and lungs, but can interfere with the proper functioning deforming them. In cases of moderate to severe chest wall is held rigidly in a previous position.Such breaths are ineffective and the patient requires the use of diaphragm and accessory muscles to breathe than normal muscles of the chest during exercise. This negatively affects gas exchange and lowers physical resistance. Patients become tired more quickly than normal people. The moderate asthma.
Some children with pectus carinatum may have scoliosis, prolapse of the mitral valve, connective tissue disorders, high blood vessels and heart valves. Although there is rarely observed and patients who may be impaired and other connective tissues, arthritis, impaired vision and wound healing. Besides possible physiological consequences, chest deformities can have a major psychological impAct.
Deformities become more severe during the rapid development in adolescence and may become worse in adulthood. Side effects such as scoliosis and cardiovascular and pulmonary conditions can abbreviate with age. Exercise for gaining muscle mass will not change the ribs and chest wall cartilage and are considered harmless.
For children up to 18 years with moderate pectus carinatum surgery and who may not wish to use a rod inserted through the sternum in the chest wall with excellent results. It works the same way as corsets and plaster or teeth straightening devices. The technique became more popular than surgery. For patients with severe pectus carinatum surgery may be necessary. Two procedures are used frequently: Nuss and Ravitch.
After the period of adolescence in some patients using body mass gaining techniques to hide their deformation and women want breast implants for the same reason. Some breast augmentation plastic surgeons prefer to mask the mild cases in women.
Pathogenesis Pectus carinatum (deformation in the hull of the chest) represents a spectrum of abnormalities of the chest above the protrusion.Deformation can be classified into condrogladiolara-condromanubriala chicken or pigeon-breast, depending on the location of prominence on the stern. Lateral deformations are also possible. Symptomatic patients reported difficulty breathing, decreased resistance to physical effort, dyspnea and chest rigid adherence to the gradual decrease pulmonary emphysema and increased respiratory tract infections. For some people the biggest problem is the physical aspect.
Barrel chest deformities with increased anterio-posterior diameter of the chest are possible forms of chronic obstructive pulmonary diseases such as cystic fibrosis and untreated or poorly controlled asthma.
Until recently most cases of pectus carinatum were considered asymptomatic. Mitral valve prolapse is found in 97% of patients.Arrhythmias and myocardial contractility, low are rarely seen, along with cardiac and hemodynamic changes. The latter are seen especially in patients with condromanubriala deformation.
Pectus excavatum is more common than pectus carinatum. The prevalence of pectus carinatum is 0. 06% at least 25% of patients had family history of the condition. Pectus carinatum may be observed in association with Marfan syndrome and congenital heart disease.
Signs and symptoms Impairment of psychological and cosmetic patients are the main reasons for presentation to the doctor. Men are affected four times more often than women. Since deformation can occur isolated or with other sidnroame, is difficult to identify a single etiology.
Although the condition has been described at birth is identified especially in childhood. Deformation worsens during adolescence.Patients report this deformity from birth until early childhood, but most children present at age 11-15 years. The degree of deformity worsens in adolescence, and most patients are asymptomatic.After deformation remains stable during adolescence.Symptomatic patients reported dyspnea and tachypnea exercise, and decreased resistance.
Physical Exam: I described two main types of deformation: condrogladiolara and condromanubriala. In most cases the deformation is symmetric.Rarely can identify asymmetric deformation or mixed. Pectus carinatum The diagnosis is clinical and is based on descriptive elements discovered during the physical inspection of the chest. Deformation may occur in isolated fashion or in association with congenital heart disease or other skeletal abnormalities, scoliosis. Joint deformities can be observed in Poland syndrome. About 25% of patients have a positive family history of chest deformities. Less commonly associated with pectus carinatum Morquio syndrome, hiperlordoza and kyphosis.
Diagnosis Imaging studies: in pectus carinatum chest CT scan shows increased anterio-posterior diameter of the chest. Haller method can be used to determine the severity index. Pulmonary function can be measured to explain the appearance of clinical symptoms and chest examined. Electrocardiography and echocardiography may be indicated in congenital heart disease if it is suspected. Cardiodinamice and hemodynamic changes are observed, with decreased myocardial contractility. Chromosome analysis and metabolic testing may also be indicated if other Dysmorphic signs are identified.
Treatment For treating conditions were recommended chest compression techniques and ghipsaj. Using a rod inserted into the patient's sternum to align the ribs is a technique that enjoys 90% compliance among patients. The ideal candidate is a skeletally immature child, moved with moderate strain. Tijarea Ghipsajul and eliminate the risks of surgery and anesthesia.
Surgical therapy: Endoscopic resection of costal cartilage with sternal osteotomy is a mini invasive technique for correction of cosmetic deformity.Prescoplari is indicated in children because skin quality and tone, and the easy difficulty rib resection from adults. It is a less expensive method and a low morbidity, short hospitalization and good cosmetic results.