A 45-Year-Old with Chest Deformity

Differential Diagnosis

• Pectus carinatum
• Pectus excavatum
• Poland syndrome
• Pentalogy of Cantrell

Diagnosis

The x-ray shows an angulated appearance of the lower sternum. This patient was diagnosed with pectus carinatum, otherwise known as a pigeon chest, in which the sternum protrudes anteriorly.

Learnings/What to Look for

• Shortness of breath and exercise intolerance are common symptoms
• Radiographic features include two patterns of sternal protrusion: chondrogladiolar (protrusion of the middle and lower sternum) and chondromanubrial (protrusion of the manubrium and upper sternum)
  • Pectus carinatum can be associated with scoliosis, Marfan syndrome, and other disorders
  • Familial occurrence is reported in approximately 25% of cases and usual diagnosis occurs during childhood or adolescence

Pearls for Urgent Care Management

• Nonsurgical external bracing may be effective, especially in adolescents
• Referral for surgical consideration may be necessary

Acknowledgement: Image and case presented by Experity Teleradiology (www.experityhealth.com/teleradiology).