Pectus Excavatum
Pectus excavatum is congenital abnormal formation in the rib cage, which causes the sternum to grow inward, this causes the look of a sunken chest. There are mild and severe cases of pectus excavatum. If this abnormal development is left untreated, it can cause pressure on the thoracic cavity including the heart and lungs. Pectus excavatum generally appears more physically prominent in adolescence into teenage years due to puberty. This deformity causes not only side effects to their physical health, but also creates a higher level of self consciousness with their body image.
The cause of pectus excavatum is not entirely understood. It has been researched that the cause of it is irregular growth of the cartilage that connects the ribs to the sternum that occurs during pregnancy. According to Pectus excavatum: MedlinePlus Medical Encyclopedia, 2013, October 18, some disorders can be linked with patients that have pectus excavatum, including: Marfan syndrome, Rickets due to the lack of vitamin D, scoliosis, Poland syndrome, and a family history of pectus excavatum. Even though family history is a risk factor, this anomaly can happen without a family history. Most parents are unaware of their child’s deformity until they begin to notice
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the sunken chest wall or they notice their child is complaining of symptoms associated with it. Symptoms of pectus excavatum include shortness of breath with even a small amount of exercise, fatigue, chest pain, tachycardia, heart palpitations, recurrent respiratory infections, coughing or wheezing, gastrointestinal reflex disorder and heart murmurs. Many patients with pectus excavatum find that sports and exercise are harder for them and tend to miss out on normal childhood activities. Patients are often put on asthma medications, GERD medications, and many other drugs until the diagnosis of pectus excavatum is given. Due to the shift of the heart to the left side, there tends to be opacity of the right side of the lung area as noted in a chest radiograph and is commonly mistaken for pneumonia. Diagnosis of Pectus Excavatum if generally suspected from a visual of the chest. The patient may be sent to specialists including a pulmonologist and a cardiologist. Diagnostic tests may be run including: a chest radiograph, echocardiogram, stress test, computed tomography of the chest, pulmonary function tests, blood work, and an electrocardiogram. As noted before, a diagnosis may not be found until later in life due to growth and development or signs and symptoms. According to Diseases & Conditions, 2015, April 28, “Pectus Excavatum accounts for almost 90 percent of congenital chest wall deformities.
Approximately 40 percent of pectus excavatum patients have one or more family members with the same defect. Pectus excavatum occurs more often in men than in women, appearing in one per every 300 to 400 Caucasian male births.” In a study of reactions of patients 11 years and older with pectus excavatum are as follows: High degree of self-observation 94%, high latent anxiety 82%, broken motivation 82%, feeling of stigmatization 78%, timidity of social contact 74%, disturbed body image 72%, ambivalence 72% and high latent aggressiveness 66% (Einsiedel, E., & Clausner, A.
(1999). Daily life with Pectus Excavatum is challenging and many patients are unaware that they actually have a treatable deformity. Many children face ridicule from their peers because of their difference in appearance. Due to the lack of self confidence, children and teens may take themselves out of situations in which they have to show their chest. The symptoms associated with Pectus Excavatum may make sports difficult and challenging. There are many online support groups for teens and adolescents facing this disorder. Depending on the severity of Pectus Excavatum many patients do not have symptoms at all and can lead a normal healthy life. It is when the symptoms become severe enough that surgical treatment is suggested. Years ago treatments were very obscure and had higher complications. Today, the surgical route is minimally invasive and has a higher success rate. Again, the surgical route is only necessary for those patients who are experiencing symptoms that affect their health to an extreme or are looking for a cosmetic enhancement. The Nuss Procedure is the most common treatment plan, since it is less surgically invasive. The goal of the procedure is to help alleviate the symptoms associated with pectus excavatum and bring them back to a normal functioning lifestyle. A small incision is made into the side of their thoracic cavity for a scope and two other small incisions made on either side of the chest are made to insert a curved steel bar, that is individually designed for each patient. The curved bar is meant to reverse the depression in the chest by inserting it under the sternum. It is then fixed to the ribs on each side. The bar is usually left in place for two to three years and then surgically removed once the depression is reversed. After the surgery, the patient remains in the hospital for five to seven days and receives pain management. Activity and anything strenuous is strictly limited for three months post operative. Heavy lifting or sports is not allowed for six months post operative. In conclusion, the prognosis of living with pectus excavatum is highly likely to be successful with or without surgery depending on the severity of the depression and symptoms associated with it. Most patients will return to their normal activities and their self esteem will rise with the appearance of a more normal looking chest. Complications are very minimal, but do include: bleeding, pleural effusion, pneumothorax, pericarditis, infection, bar displacement, and recurrence of pectus excavatum after the bar has been removed.
On Thursday November 2, 2000, 15 year old Lewis Blackman checked into Medical University of South Carolina Children’s Hospital (MUSC) in Charleston for elective surgery on his pectus excavatum, a congenital
Jeannette’s timid nature is a shared characteristic that we both share. This was evident through her reluctance to take off her dress while she was at the community pool with her classmate, Dinitia and other women. She was self-conscious about her body and the scar that was on her ribs as a result from an accident she had at three years old cooking hot dogs. After a few moments of encouraging herself, she was able to take off her dress and put on a bathing suit. Like Jeannette, I have struggled with shyness when it comes to body image. I started puberty at eight years old, and the children I went to school with, were relentless in teasing me about having to wear a bra. This caused my self-esteem to plummet and lead me to bind my chest with tape
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Lewis Blackman was a fifteen year old boy whose death was triggered by the numerous errors caused by his healthcare professionals. He was suffering from a Pectus Excavatum, a non-life threatening condition. His mother, Helen Haskell, was attracted to an advertised surgery that boasted all the benefits of the procedure without proclaiming the risks. He checked into the Medical University of South Carolina Children’s Hospital on November 2nd, 2000, to undergo this “safe and minimally invasive” procedure. Complications arose following the surgery, but they were not communicated effectively within the nursing co...
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