title: A Cross-Sectional Study of Chest Wall Development in Patients with Pectus Excavatum.
abstract: BACKGROUND
  We conducted a cross-sectional study to quantify the developmental changes of the thoracic cage in patients with pectus excavatum (PE).
  
  
  METHODS
  The preoperative posteroanterior standing chest radiographs (chest PAs) of 1,197 consecutive patients with PE, together with 1,661 age- and sex-matched minor surgery patients, as a control group, who were seen between June 2005 and February 2013, were reviewed. The maximum width of each rib pair and chest height (H) were measured on the chest PA.
  
  
  RESULTS
  In the PE group, the normal thoracic contour in younger patients was replaced by a characteristic can-shaped chest wall, which showed protrusion of the upper ribs, an increased H, and a straightened lateral border of the chest cage, as they grew into adulthood. The chest height difference between the PE and control groups increased progressively, from the age of 8 years and most significantly from age 13 to 17 years. No difference was observed in the middle and lower rib widths. Sex did not influence these trends.
  
  
  CONCLUSIONS
  The PE chest wall shows a significant increment in chest height, and upper rib width starts during the period of rapid growth and is maintained into adulthood. The thoracic deformity in patients with PE includes more than just the sternal deformity.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang-Gung University, College of Medicine, Taoyuan, Taiwan.
authors.forename: Pei-Yeh
authors.initials: PY
authors.lastname: Chang
authors.affiliation: Department of Pediatric Surgery, Beijing Children Hospital, Capital Medical University, Beijing, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Zeng
authors.affiliation: Department of Pediatrics, Chang Gung Memorial Hospital, Chang-Gung University, College of Medicine, Taoyuan, Taiwan.
authors.forename: Kin-Sun
authors.initials: KS
authors.lastname: Wong
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang-Gung University, College of Medicine, Taoyuan, Taiwan.
authors.forename: Jin-Yao
authors.initials: JY
authors.lastname: Lai
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang-Gung University, College of Medicine, Taoyuan, Taiwan.
authors.forename: Jeng-Chang
authors.initials: JC
authors.lastname: Chen
authors.affiliation: Department of Radiology, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
authors.forename: Chao-Jan
authors.initials: CJ
authors.lastname: Wang
authors.affiliation: Chang Gung Memorial Hospital, Resources Center for Clinical Research, Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chee-Jen
authors.initials: CJ
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D066186:Costal Cartilage / Q000000981:diagnostic imaging / Q000254:growth & development*; D003430:Cross-Sectional Studies; D005260:Female; D005660:Funnel Chest / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D011379:Prognosis; D013902:Radiography, Thoracic / Q000379:methods; D012016:Reference Values; D012272:Ribs / Q000000981:diagnostic imaging / Q000254:growth & development*; D012737:Sex Factors; D035441:Thoracic Wall / Q000002:abnormalities / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult