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1. First sight assesement

During the first interview with the patient and his/her parents we learn about patient's attitude towards  the ailment. Children will easily accept the proposed treatment provided the parents are ready to comply. 

We 'd rather be reluctant to embark on non-operative management in adolescents who leave the talk with the doctor or physiotherapist to their parents  or show little interest in their problem. We would rather consider postponing the treatment for some time until the patient appears motivated enough to cooperate.
Adult patients expect quick improvement and are  ready to comply. 

Bad posture accompanying pectus deformities remains the number 1 goal in nonoperative management. 


First sight assessement:

    •    depth of the depression

    •    symmetry

    •    flare ribs

    •    posture

2. Computerised Axial Tommography CAT scan

CAT scan or NMR scan reveals

    •    real Haller index (bone to bone) at different locations (normal 2.52) - here 5.2 cm leaves little room for the heart

    •    rib/sternum impression on the heart as seen in the scan

    •    heart displacement

    •    skoliosis

    •    flaring of the ribs



    •    valve regurgitation, mostly mitral (14%)

    •    heart arrythmias

    •    heart murmurs

    •    aortic arch defects (Marfan's syndrome) 

4. Spirometry

    •    reduced tidal volume during normal breathing

    •    asthma-like restriction of vital lung capacity

    •    breath shortness

    •    spirometry of lesser value in most pectus patients

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