Pectus Excavatum

I am a 44 yr old female, life long asthmatic and have always had a "pointy rib cage", to the point that I was never comfortable in 2 piece swim suits.  Other than that, my odd shaped rib cage was never an issue.  I also have issues with recurrent pneumonia and bronchitis (yearly almost).  Meaning, I have had many chest xrays.  This past spring (March 2012) I had pneumonia and went to the local walk in clinic and then my primary doc a few days later, both took xrays and both individually told me I had Pectus Excavatum.  Reports say 1: Severe pectus excavatum which does narrow the chest cavity to approximately 7mm and likely does result in mass effect upon left ventricle. 2: Significant pectus excavatum posteriorly displacing and widening the heart which projects mildly enlarged resultantly.Ok, now on to the question.  It has been a year and just recently (past month) I notice that when I lay on my left side and my right arm comes across my chest, I feel a pressure where I imagine my heart is located.  It is not painful, but it is uncomfortable and I can not sleep this way.  I am moving around quite a bit trying to get comfortable.  I noticed too, that as a passenger in a car, when I reach over with my right hand to change radio stations, I feel the same pressure.  Is this on my heart?  Should I be worried?When I feel this pressure I arch my back and it seems to relieve it immediately.  Should I get in to a specialist?  Can this pectus excavatum worsen with age?Thank You.

Is this what you are writing about? It is indeed called a pectus excavatum. If severe, it may compress and displace your heart and lungs and may need to be fixed. It is sometimes associated with other anomalies such as scoliosis and occasionally, Marfan syndrome and Mitral Valve prolapse (MVP)  occurs in this type of patient. MVP occurs more often in women than in men.

These episodes of recurrent respiratory illnesses and discomfort made worse with positioning are indeed suggestive of complications associated with a pectus excavatum. Whether this is just because of local compression of your heart and/or lungs, or because of other cardiac problems such as MVP, I don't know.

However, your symptoms are such that I recommend a complete evaluation that may well lead to corrective surgery. It should include a cardiac echo, a CT scan such as the one above, lung function studies, as well as consultations with probably a cardiologist and finally a thoracic surgeon with experience in this type of operations (not every one will be!)

Hope this helps,
Dr T


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