funnel chest
Introduction
Funnel chest introduction Funnel chest is a congenital and often familial disease. Males are more common than females. There are reports that the ratio of male to female is 4:1. It is a sexually dominant hereditary, mainly manifested as the sternum and ribs in the middle part of the anterior chest of children. The cartilage and part of the ribs are deformed to the dorsal side, forming a funnel shape. The sternum of most funnel chests starts from the level of the 2nd or 3rd costal cartilage to the dorsal side, to the lowest point on the xiphoid process, forming a ship-like or funnel-like deformity. The organs in the thoracic cavity are oppressed and even displaced, and the heart and lung development and function of the child are seriously affected. basic knowledge The proportion of sickness: 0.01% Susceptible people: good for children Mode of infection: non-infectious Complications: Asthma
Cause
Funnel chest cause
Genetic factors (30%):
Men are more common than women, and there are reports that the ratio of male to female is 4:1, which is a companion dominant inheritance. The incidence of funnel chest with a family history was 2.5 , and the incidence of funnel chest was only 1.0 without family history. The cause of the funnel chest is unknown and is believed to be related to heredity.
Physiological factors (20%):
Some people think that this deformity is due to the uncoordinated growth of the ribs, the lower part is smaller than the upper part, and the sternum is extruded backwards. It is also thought that the sternum is attached to the lower end of the sternum and the xiphoid in front of the iliac muscle. And the xiphoid is pulled backwards.
Pathogenesis
The age of the funnel chest patient is often symmetrical. As the age increases, the funnel chest gradually becomes asymmetrical, the sternum tends to rotate to the right, and the right costal cartilage is often deeper than the left side, and the right breast is more developed. Lateral, the back chest is mostly flat back or round back, scoliosis gradually increases with age, infant scoliosis can not be obvious, scoliosis is more obvious after puberty.
Prevention
Funnel chest prevention
The funnel chest is a congenital and often familial disease. Men are more common than women, and there are reports that the ratio of male to female is 4:1, which is a companion dominant inheritance. The main manifestation is that the sternum in the middle part of the anterior chest of the child drives the connected ribs to collapse into a funnel shape, which causes the organs in the thoracic cavity to be pressed and even displaced, and the heart and lung development and function of the child are seriously affected.
prevention:
The disease is a familial dominant genetic disease with no effective preventive measures. Precautions should be taken for children with less severe thoracic deformities to prevent their continued development.
In the 1970s, the youngest patients with such surgery were about 4 to 5 years old. The current optimal age for surgery depends on the hospital conditions and the level of the surgeon. Experts believe that according to the characteristics of children's bone, the best time to correct the funnel chest is 2 to 4 years old, low-grade surgery can not affect children's development. At present, children with 1-3 years old have such surgery, and most of the results are very good.
Complication
Funnel chest complications Complications asthma
For example, the thoracic deformity caused by the funnel chest is more serious, the organ heart in the thoracic cavity, the lung is subjected to different degrees of compression, and even the heart is displaced, and the lung ventilation function is also affected. If further developed, it is prone to serious diseases such as respiratory infection. Sometimes combined with lung hypoplasia, Marfan syndrome, asthma and other diseases.
Symptom
Funnel chest symptoms Common symptoms Thoracic deformity wheezing dyspnea arrhythmia pleural effusion myocardial ischemia scoliosis heart palpebral conduction block systolic murmur
Funnel chest males are more common than females. The ratio of male to female is 4:1. It is a sexually dominant hereditary, more common under 15 years old, and rare in 40 years old. This may be due to severe funnel chest and scoliosis compression of the heart and lungs. Respiratory and circulatory failure, decreased lung capacity, increased functional residual capacity, and reduced activity tolerance, so critically ill patients die before the age of 40; and mild patients over 40 years of age rarely see a doctor.
The funnel chest is a sternum, the costal cartilage and a part of the ribs form a funnel-shaped deformity to the spine. The sternum of most funnel chests starts from the level of the second or third costal cartilage, and the lowest point on the xiphoid Point, and then forward to form a ship-like deformity, both sides or outside, inwardly deformed to form the two sides of the funnel chest, the ribs of the funnel chest are more inclined than the normal person, and the ribs are steeply recessed from the upper rear to the lower side. To make the front and back become close, in severe cases, the deepest depression of the sternum can reach the spine.
The age of the funnel chest patient is often symmetrical. As the age increases, the funnel chest deformity gradually becomes asymmetrical, the sternum tends to rotate to the right, and the right costal cartilage is often deeper than the left, the right breast. The development is worse than the left side, the back chest is mostly flat back or round back. The scoliosis is gradually aggravated with age. It is not easy to have scoliosis when the age is young. The scoliosis is more obvious after puberty. The funnel chest deformity oppresses the heart and lung, the heart is mostly Displacement to the left thoracic cavity, the child often presents a unique weak posture: the neck stretches forward, the rounded shoulders, the canopy.
The slight funnel chest can be asymptomatic, the deformed heavier pressure on the heart and lungs, affecting respiratory and circulatory functions, reduced lung capacity, increased functional residual capacity, reduced activity tolerance, frequent respiratory infections in children, coughing, fever, often diagnosed as Bronchitis or bronchial wheezing, children with less circulatory symptoms, older can have difficulty breathing after activity, pulse fast, palpitations, and even pain in the anterior region, the main country is because the heart is under pressure, cardiac output during exercise Can not meet the needs, myocardial hypoxia, and thus cause pain, some patients can also have arrhythmia, as well as systolic murmur.
Examine
Funnel chest inspection
Description method
1. Body surface ripple domain map is a method to objectively describe the deformity. It uses the light source and grid projection method to take pictures of the corrugated contour lines of the concave part of the chest wall, according to the interval and number of corrugated contour lines. The digitizer is input to an electronic computer to calculate the volume of the depressed portion, determine the severity of the funnel malformation, and evaluate the effect of the surgical treatment.
2. The funnel index (FI) is another method of expressing malformations.
FI = ( a × b × c ) ÷ ( A × B × C )
a. the longitudinal diameter of the recessed portion of the funnel chest; b. the transverse diameter of the depressed portion; c. the depth of the depressed portion.
A. The length of the sternum; B. The transverse diameter of the thorax; C. The shortest distance from the chest muscle angle to the vertebral body.
The criteria for judging the extent of the funnel chest depression are:
Severity: FI>0.3, moderate 0.3>FI>0.2, mild: FI<0.2.
3. The water in the funnel is measured by the water. The patient is placed on the back of the bed. The water is injected into the funnel and the water volume is measured. The severity of the funnel chest can also be known. The volume of the heavy funnel chest can reach 200 ml. Some people use plasticine to fill the funnel chest. After removing the plasticine from the shape, the volume of the recessed portion of the funnel chest can be easily measured by immersing it in water.
X-ray examination can see the posterior part of the rib straight, the front part is tilted down forward and downward, the heart shadow is shifted to the left side of the chest cavity, and there is a distinct radioactive translucent area in the middle of the heart shadow. The spine overlaps, and the heart shadow of some severe patients can be completely located in the left thoracic cavity. The older patients have more scoliosis in the spine. The lateral chest radiograph can see the sternum body bending backward obviously. Some lower sternum can reach the front edge of the spine. .
Back front photo: transparent area in the heart of the funnel chest
Chest CT films can more clearly show the severity of thoracic deformity and the degree of cardiac compression.
The electrocardiogram can be expressed as V1 P wave inversion or bidirectional, or right bundle branch block, cardiac catheterization can be traced to diastolic slope and platform, as seen in constrictive pericarditis, cardiovascular angiography shows right heart The pressure deformity and the right ventricular outflow tract are blocked.
Diagnosis
Funnel chest diagnosis
It is very easy to diagnose clinically, the malformation is clear at a glance, no need to identify it, and it is different from another common thoracic deformity-chicken chest. The chicken breast is a wedge-shaped bulge on the chest wall, which is named after the sternum of the bird. The funnel chest is A concave deformity of the chest wall, shaped like a funnel.
