title: Dysmorphology of chest wall deformities: frequency distribution of subtypes of typical pectus excavatum and rare subtypes.
abstract: OBJECTIVE
  More than forty percent of patients with pectus excavatum have a family history of chest deformity. However, no studies of the frequency of the different phenotypes of pectus excavatum have been published.
  
  
  METHODS
  A random sample of 300 non-syndromic pectus excavatum patients, from the chest wall deformities clinic at Children's Hospital of The King's Daughters in Norfolk, Va., was studied and classified according to a previously described classification system. Photographs and computed tomography (CT) scans were utilized.
  
  
  RESULTS
  Typical pectus excavatum. Photo data: localized deep depression (cup-shaped) deformity occurred in 67%; diffuse (saucer-shaped) 21%, trench-like (furrow-shaped) 10%, and Currarino-Silverman (mixed pectus excavatum/chondromanubrial carinatum) 1%. The deepest point was to the right of midline in 80%, left in 10% and central in 10%. By photo, the deepest point was in the lower sternum in 75%. When asymmetric, the deepest point of the deformity was to the right of midline in 90%. CT data: the average Haller index was 4.9. Severe sternal torsion (>30 degrees) was associated with greater Haller index (6.3) than mild torsion (4.5). The deepest point of the depression was at the mid- or lower sternum in more than 99%. It proved impossible to estimate width or length of the depression because of poorly defined borders.
  
  
  CONCLUSIONS
  Typical PE is cup-shaped in 67% of cases, to the right of the midline in 80%, and involving the mid-to-lower sternum in 99%. However, other phenotypes, like the saucer and long trench, comprised one-third. Definition of the deformity is more reliable by CT scan.
authors.affiliation: Department of Surgery, Eastern Virginia Medical School and Children's Hospital of the King's Daughters, Norfolk, VA, USA. Robert.Kelly@chkd.org
authors.forename: Robert E
authors.initials: RE
authors.lastname: Kelly
authors.forename: Amy
authors.initials: A
authors.lastname: Quinn
authors.forename: Patricio
authors.initials: P
authors.lastname: Varela
authors.forename: Richard E
authors.initials: RE
authors.lastname: Redlinger
authors.forename: Donald
authors.initials: D
authors.lastname: Nuss
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005660:Funnel Chest / Q000145:classification / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000235:genetics / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D010641:Phenotype; D012189:Retrospective Studies; D012494:Sampling Studies; D013249:Sternum / Q000002:abnormalities / Q000000981:diagnostic imaging; D035441:Thoracic Wall / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014768:Virginia / Q000453:epidemiology; D055815:Young Adult