Prevalence of pectus excavatum in an adult population-based cohort estimated from radiographic indices of chest wall shape

Abstract

Background Pectus excavatum is the most common chest wall skeletal deformity. Although commonly evaluated in adolescence, its prevalence in adults is unknown. Methods and findings Radiographic indices of chest wall shape were analyzed for participants of the first (n = 2687) and second (n = 1780) phases of the population-based Dallas Heart Study and compared to clinical cases of pectus (n = 297). Thoracic computed tomography imaging studies were examined to calculate the Haller index, a measure of thoracic axial shape, and the Correction index, which quantitates the posterior displacement of the sternum relative to the ribs. At the level of the superior xiphoid, 0.5%, 5% and 0.4% of adult Dallas Heart Study subjects have evidence of pectus excavatum using thresholds of Haller index >3.25, Correction index >10%, or both, respectively. Radiographic measures of pectus are more common in females than males and there is a greater prevalence of pectus in women than men. In the general population, the Haller and Correction indices are associated with height and weight, independent of age, gender, and ethnicity. Repeat imaging of a subset of subjects (n = 992) demonstrated decreases in the mean Haller and Correction indices over seven years, suggesting change to a more circular axial thorax, with less sternal depression, over time. Conclusions To our knowledge, this is the first study estimating the prevalence of pectus in an unselected adult population. Despite the higher reported prevalence of pectus cases in adolescent boys, this study demonstrates a higher prevalence of radiographic indices of pectus in adult females.

Cardiopulmonary function in adolescent patients with pectus excavatum or carinatum

“…We observed male preponderance (93%) in a higher degree than previously published. 22 A high proportion of patients presented chest pain, 20% of PE and 15% of PC possibly linked to unusual muscular and nerve insertion. None of the patients presented Marfan or Beighton scores high enough to suspect hyperlaxity.…”

Can categorised values of maximal oxygen uptake discriminate patterns of exercise dysfunction in pectus excavatum: a prospective cohort study?

“…[4][5][6][7][8] CONCLUSION PE has a reported prevalence of 0.49%-1.28%, an estimated incidence of 300,000 -600,000 cases in the UK population of 65 million. [1][2][3] In the years before 2019, only 250 cases received surgical treatment annually, arguably a highly selected group of patients. 30 Since 2019, NHS England has prevented, by the withdrawal of funding, treatment of patients with PE, having concluded PE does not significantly impact on patients' lives.…”

The Epidemiology behind Pectus Excavatum: Clinical Study and Review of the Literature

“…Additionally, it is suspected that females often remain undiagnosed due to visual concealment of aspects of PE by breast tissue. 17 A genetic cause of this skewed tendency toward male was hypothesized in 2006 by Creswick et al, who proposed (partial) X-linked inheritance of the disease or a gender-favored multifactorial inheritance pattern. 1 Due to the fact that maternal grandfathers were four times more likely to be affected than paternal grandfathers with unaffected female generations in between, we agree with this hypothesis and propose X-linked inheritance as one of the likely inheritance patterns for isolated PE.…”