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1. Pectus excavatum

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Figure 8-1

Pectus excavatum.

An axial CT image of a 17-year-old boy with severe pectus excavatum shows posterior deviation of the sternum. The sternum has a tipped configuration, and there is asymmetry of the associated anterior chest wall deformity. The heart is shifted to the left.

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2. Pectus excavatum

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Figure 8-2

Pectus excavatum.

A. An axial T2-weighted MR image of a 4-year-old child with neurofibromatosis type 1 demonstrates severe pectus excavatum deformity (Haller index = 9.2). There is also torsion of the sternum. The heart is deviated to the left and there is compression of the right atrium. B. A sagittal fat-suppressed T2-weighted image shows posterior deviation of the inferior aspect of the sternum and anterior deviation of the superior aspect. The hyperintense tissue in the mediastinum and anterior chest wall represents a plexiform neurofibroma.

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3. Pectus excavatum

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Figure 8-3

Pectus excavatum.

A, B, C. Chest radiographs of 3 children with pectus excavatum deformities of varying severity. Each child has obscuration of the right-heart border, leftward deviation of the heart, and variable straightening of the left-heart border. The anterior portions of the ribs angle inferiorly.

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4. Pectus excavatum

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Figure 8-4

Pectus excavatum.

A lateral chest radiograph of a 15-year-old boy shows posterior deviation of the inferior aspect of the sternum and the adjacent soft tissues (arrow).

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5. Pectus excavatum

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Figure 8-5

Pectus excavatum.

A right anterior oblique three-dimensional CT image of a 15-year-old boy shows posterior deviation of the inferior portion of the sternum. The anterior aspects of the ribs turn inferiorly and posteriorly. The costal cartilages curve posteriorly to meet the sternum.

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6. Haller index

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Figure 8-6

Haller index.

A. An axial CT image of a 10-year-old child with mild pectus excavatum deformity demonstrates a Haller index of 2.93 (23.12/7.89 cm). B. A 12-year-old child with a more severe form of pectus excavatum has a Haller index of 4.11 (26.13/6.35 cm).

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7. Pectus carinatum

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Figure 8-7

Pectus carinatum.

A lateral radiograph of a 16-year-old patient shows anterior protrusion of the inferior aspect of the sternum.

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