Crystina Ayu Putri, Putu Ayu Winda Wirastuti Giri, Ni Nyoman Margiani

Beyond the curved radiologic insights into dual chest wall deformities in a pediatric patient: a case report series

Introduction

Beyond the curved radiologic insights into dual chest wall deformities in a pediatric patient: a case report series. Explore unique pediatric cases of dual chest wall deformities, including pectus excavatum & carinatum. Learn how radiology is crucial for diagnosis, severity, and guiding treatment, preventing misdiagnosis and optimizing outcomes.

Abstract

Introduction: Chest wall deformities are congenital abnormalities of the sternum, ribs, and costal cartilage, most commonly presenting as pectus excavatum (sternal depression) or pectus carinatum (sternal protrusion). These conditions may cause cardiopulmonary dysfunction and psychosocial distress, particularly in adolescents. Radiology is essential for diagnosis, severity assessment, and treatment planning, utilizing indices such as the Haller Index and Pectus Correction Index (PCI). This report is unique as it describes diverse pediatric presentations, including a female adolescent with severe pectus excavatum, a case mimicking a chest wall tumor, and one combined with scoliosis. Case description: We report four pediatric cases with distinct chest wall deformities. Two adolescents presented with severe pectus excavatum (Haller Index >3.25), one with asymmetry and cardiac deviation, and another with symmetrical deformity. Two other patients demonstrated pectus carinatum, initially suspected to be chest wall tumors, confirmed by CT scan with Haller Index for Carinatum. Management varied from conservative bracing to surgical correction using the Nuss procedure, depending on severity and patient preference. Conclusion: This series highlights the critical role of imaging in differentiating deformities, quantifying severity, and guiding management. Radiology also enables monitoring of postoperative outcomes and complications. Early recognition and appropriate evaluation are vital to prevent cardiopulmonary compromise and long-term psychosocial impact. Radiology not only confirms the diagnosis but also prevents misdiagnosis and inappropriate interventions.

Review

This case report series, "Beyond the curved radiologic insights into dual chest wall deformities in a pediatric patient," offers a compelling look into the diverse and sometimes challenging presentations of chest wall deformities in pediatric populations. The authors adeptly emphasize the pivotal role of radiology beyond basic diagnosis, showcasing its capacity to differentiate complex conditions, assess severity with objective indices, and critically, to prevent misdiagnosis. By focusing on unique cases, including those mimicking tumors and those combined with other spinal deformities, the paper effectively highlights the diagnostic dilemmas clinicians may face and the invaluable contribution of imaging in clarifying these complexities. The strength of this series lies in its detailed illustration of specific clinical scenarios where precise radiological evaluation proves indispensable. The report meticulously describes cases ranging from severe pectus excavatum with varying symmetry to pectus carinatum initially misidentified as chest wall tumors. Through the application of established metrics like the Haller Index and CT scans, the authors demonstrate how imaging guides critical management decisions, from conservative bracing to surgical interventions like the Nuss procedure. This emphasis on practical application underscores the utility of radiology in not only confirming the presence of a deformity but also in determining the most appropriate course of action and monitoring outcomes. Overall, this case series serves as an important reminder of the multifaceted value of comprehensive radiological assessment in pediatric chest wall deformities. While a series of cases inherently offers specific rather than generalized findings, it strongly reinforces the broader message that early and accurate imaging is fundamental to preventing diagnostic pitfalls, minimizing unnecessary interventions, and ultimately improving long-term patient outcomes. The work implicitly advocates for a vigilant approach to evaluation, ensuring that clinicians fully leverage radiologic insights to address both the physical and psychosocial impacts of these conditions effectively.

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