Pectus excavatum in children: pulmonary scintigraphy before and after corrective surgery.

Blickman, J G; Rosen, Paul R.; Welch, Kristin; Papanicolaou, Nicholas; Treves, S. Ted

doi:10.1148/radiology.156.3.4023243

Cited by 34 publications

(15 citation statements)

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“…The findings are consistent with previous reports [17][18][19]. Blickman et al [20] reported that impairment of either ventilation or perfusion or both are observed primarily in the left lower lung, and that surgery improves these abnormalities in virtually all patients with PE. Thus, we speculate that moving the mediastinum to its correct position by surgical repair may contribute in part to improved pulmonary perfusion followed by relief of symptoms and increased stroke volume.…”

Section: Discussionsupporting

confidence: 93%

Left displacement of the mediastinum determines the imbalance in the pulmonary vascular bed and lung volume in children with pectus excavatum

et al. 2008

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The purpose of this study was to determine the influence of morphologic alteration on lung function in children with pectus excavatum (PE) and to establish the usefulness of chest radiography to predict the imbalance of pulmonary perfusion and lung volume. Chest radiography, pulmonary perfusion scintigraphy, and computed tomography (CT) for calculation of each lung volume were performed in 38 children with PE. To assess the relationship between position change of the mediastinum and lung, the following indices were calculated: (1) vertebral index (VI); the severity of sternal depression on the lateral chest radiograph, (2) left displacement index (LDI); the ratio between the left border of the mediastinum and the left border of the thorax to the transverse thoracic dimension on posterioanterior chest radiography; (3) left-to-right count ratio for the lung scintigraphy (Ls/Rs), and (4) the left-to-right thorax volume ratio from the CT scan (Lv/Rv). Compared to children without PE, VI was significantly higher, and LDI was lower in patients with PE. Pulmonary perfusion scintigraphy and CT showed that left pulmonary perfusion and lung volume were significantly lower than in the right lung in PE. LDI showed a close correlation with Ls/Rs (R = 0.443, P = 0.005) and Lv/Rv (R = 0.703, P < 0.001). Left displacement of the mediastinum within the closed thoracic cavity directly imposes constraints on the left lung, resulting in reductions of perfusion and lung volume that likely determine the physiologic severity of lung function in PE. Posterioanterior chest radiography might be useful in predicting the severity of PE.

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Section: Discussionsupporting

confidence: 93%

Left displacement of the mediastinum determines the imbalance in the pulmonary vascular bed and lung volume in children with pectus excavatum

et al. 2008

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“…A total of 313 pectus excavatum patients were assessed in the meta-analysis. Four studies did not report a pectus severity index [13,34,36,39], whereas the remaining studies used various techniques for estimating a pectus severity index [6][7][8]12,37,40,41]. Therefore, the relationship between pectus severity and the average ES for each study could not be examined in the present study.…”

Section: Study Characteristicsmentioning

confidence: 96%

“…Furthermore, reference lists from original and review articles were reviewed to identify any studies that had not been previously identified from the computerized searches. As a result, 19 studies met all of the inclusion criteria [6][7][8]11,13,[34][35][36][37][38][39][40][41][42][43][44][45][46]. The studies by Gyllensward et al [44,45] and Borowitz et al [46] did not provide sufficient statistical information to estimate ESs for pulmonary function indices for patients who had surgical repair.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Therefore, a total of 12 studies were analyzed for the meta-analysis ( Table 1). Six of the studies were conducted in the United States [6,8,15,34,39,40], while the remaining studies were conducted in Belgium [13], Canada [41], Japan [37], Poland [7], Netherlands [12], and China [36]. A total of 313 pectus excavatum patients were assessed in the meta-analysis.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Approximately 40% of pectus excavatum patients are aware of one or more members of their family who have pectus deformities; however, a genetic link has not been established [4]. Despite numerous published reports, there is no consensus in the literature as to whether surgical repair improves pulmonary function [5][6][7][8][9][10][11][12]. Thus, it has been suggested by some researchers that correction of pectus excavatum should be considered a cosmetic procedure [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pulmonary function following surgical repair of pectus excavatum: a meta-analysis

Malek

Berger

Marelich

et al. 2006

European Journal of Cardio-Thoracic Surgery

108

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The purpose of this study was to use a meta-analytical technique to examine the efficacy of surgical repair of pectus excavatum on pulmonary function. Studies were retrieved via computerized literature searches, cross-referencing from original and review articles. Inclusion criteria were as follows: (1) reporting quantitative measures of preoperative and postoperative pulmonary function; (2) published in the English language; (3) indexed between January 1960 and September 2005; (4) reporting the duration between which preoperative and postoperative assessments were conducted; and (5) describing the pulmonary assessment procedures. The titles and abstracts of potentially relevant articles were reviewed to determine whether they met the criteria for inclusion. Twelve studies representing 313 pectus excavatum patients met the inclusion criteria and were used for the meta-analysis. Random-effects modeling yielded a mean weighted effect size (ES) for pulmonary function which was statistically nonsignificant (ES=0.08, 95% CI=-0.20 to 0.35; P=0.58). The findings of the present study indicated that surgical repair of pectus excavatum does not significantly improve pulmonary function. These findings, however, may be a result of testing pulmonary function under conditions in which pectus excavatum does not manifest itself.

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The Contribution of Nuclear Medicine to Pulmonary Imaging

Gelfand¹,

Gilday²

2014

Pediatric Chest Imaging

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Pectus excavatum in children: pulmonary scintigraphy before and after corrective surgery.

Cited by 34 publications

References 0 publications

Left displacement of the mediastinum determines the imbalance in the pulmonary vascular bed and lung volume in children with pectus excavatum

Left displacement of the mediastinum determines the imbalance in the pulmonary vascular bed and lung volume in children with pectus excavatum

Pulmonary function following surgical repair of pectus excavatum: a meta-analysis

The Contribution of Nuclear Medicine to Pulmonary Imaging

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