Growth disturbance of the sternum and pectus deformities: imaging studies and clinical correlation

Abstract

Sternal growth seems to have an important influence on the development of carinatum superior; partial influence on carinatum inferior, carinatum lateral, and excavatum localized; and no influence on excavatum wide pectus deformities. The endochondral growth of the sternum and costal arches is an important concept that aids in the interpretation of imaging studies and the orthopedic approach to management of these deformities in children and adolescents.

Congenital sternal foramen in a stillborn Holstein calf

“…The sternum is one of the skeleton parts with different variations and anomalies in appearances. In human, these malformations and anomalies are frequently detected accidentally by radiology [10,11] , multiplanar and 3D reconstructed CT images [12] , and MRI [13] . Reported developmental anomalies of sternum included branched xiphoid process, V-shaped bifurcation, sternum bifidum, synchondrosis sternii (incomplete ossification of the sternum), anomalies in the shape of the sternum (wedgeshaped or asymmetrical bone), sternum gallinaceum and sternal foramen.…”

Chest Wall Deformities: An Overview on Classification and Surgical Options

“…The deformity is a protrusion of the sternum and chondrocostal joints (figure 2). The etiology is unknown, but the pathogenetic mechanism could be the same than for PE, consisting in an overgrowth of the ribs (Haje et al, 1999). The same anomalies in the costal ribs than in PE have been reported in PC patients .…”

“…A study on genetics of PE showed that the most frequent transmission pattern seems to be the autosomal dominant, but there are families with autosomal recessive and X-linked patterns (Creswick et al, 2006). The overgrowth of costal cartilages could be the pathogenetic mechanism leading to the development of PE Haje et al, 1999;Kelly, 2008). Collagen type II disorders have been demonstrated in the costal cartilages in PE (Feng et al, 2001), as well as overexpression or downregulations of some genes playing a role in the metabolism of cartilage and connective tissues, as collagen genes, matrix metalloproteinases, tumor necrosis factor-alpha, and filamin PE patients have often a typical aspect: they are slim and tall, with some degree of joint laxity, rounded shoulders with a kyphotic habit and a "pot belly" (Colombani, 2009).…”

Pectus carinatum

“…Subsequently, in a radiological study of sternal growth, it was demonstrated that the growth provided by the cartilaginous growth plates is important in the development of upper, lower and lateral PC, as well as in the localized form of PE. (16) Other authors reported a case that could be designated iatrogenic PC in a 17-year-old patient who was submitted to a thymectomy through median sternotomy for the treatment of myasthenia gravis. The probable cause of PC in that case was the lesion in the centers of sternal ossification, responsible for the sternal fusion that is completed between 16 and 25 years of age.…”