Characteristics

• Also known as a funnel chest.

• Relatively common thoracic skeletal anomaly.

• Represents posterior depression of the sternum with closer approximation of the sternum to the spine.

• The majority are isolated cases, but it can be associated with congenital heart disease and Marfan's syndrome.

Clinical features

• The majority have no symptoms.

• May be exertional dyspnoea.

• Patients with concomitant conditions or syndromes may have symptoms and signs related to these associated problems.

Radiological features

• CXR (PA film) – shift of the heart to the left with straightening of the left heart border. The right heart border is indistinct. The posterior ribs appear horizontal and the anterior ribs are angulated steeply (so called ‘sevens – reverse sevens’ appearance).

• The lateral CXR confirms the depression of the sternum and the narrow AP diameter of the thorax.

Differential diagnosis

• Right middle lobe collapse/consolidation mimics pectus on the frontal CXR. A lateral film allows for accurate differentiation.

Management

• No active treatment required.