Costal Cartilages Do Not Overgrow in Patients with Pectus Excavatum

Objective: The purpose of this study was to determine whether or not patients with pectus excavatum (PE) exhibit costal cartilage overgrowth compared to normal subjects. Materials and Methods: The computed tomography acquisitions of 32 patients with PE and 35 normal controls were analyzed. On axial...

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Published inMedical principles and practice Vol. 25; no. 6; pp. 533 - 538
Main Authors David, Vlad-Laurentiu, Cerbu, Simona, Haragus, Horia, Popoiu, Marius-Calin, Stanciulescu, Corina-Maria, Cozma, Gabriel, Burlacu, Ovidiu, Boia, Eugen-Sorin
Format Journal Article
LanguageEnglish
Published Basel, Switzerland S. Karger AG 01.01.2016
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ISSN1011-7571
1423-0151
1423-0151
DOI10.1159/000449133

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Abstract Objective: The purpose of this study was to determine whether or not patients with pectus excavatum (PE) exhibit costal cartilage overgrowth compared to normal subjects. Materials and Methods: The computed tomography acquisitions of 32 patients with PE and 35 normal controls were analyzed. On axial images the length of the 4th-7th costal cartilages was measured to calculate the Haller index. The ratio between the length of the cartilages and the median of the transverse and longitudinal thorax diameters were recorded to account for anatomical variability. The length of the cartilages was compared between the PE and control subjects using the independent-samples t test. For patients with asymmetric PE the length of the 4th-7th costal cartilages was compared between the rotated and nonrotated sides. Results: The mean transverse and coronal thorax diameters were 233.29 ± 24.47 and 231.69 ± 22.47 mm for PE patients and 252.67 ± 37.25 and 238.64 ± 27.40 mm for controls, respectively, with no significant differences between the two groups (p = 0.816 and 0.145). The mean sagittal diameter (59.30 ± 14.21 mm) and Haller index (4.02 ± 1.34) in the PE group were significantly different from the controls (107.34 ± 19.59 and 2.2 ± 0.54 mm, respectively; p = 0.00). Actual and relative lengths of costal cartilages were similar in both PE subjects and controls for all 4 costal cartilages measured. In subjects with asymmetric PE, both relative and absolute costal cartilage lengths were similar on the rotated and nonrotated side. Conclusions: The length of the 4th, 5th, 6th and 7th costal cartilages was similar in PE patients and the control subjects. These was also similar between the rotated and nonrotated sides of the sternum in patients with asymmetric PE.
AbstractList Objective: The purpose of this study was to determine whether or not patients with pectus excavatum (PE) exhibit costal cartilage overgrowth compared to normal subjects. Materials and Methods: The computed tomography acquisitions of 32 patients with PE and 35 normal controls were analyzed. On axial images the length of the 4th-7th costal cartilages was measured to calculate the Haller index. The ratio between the length of the cartilages and the median of the transverse and longitudinal thorax diameters were recorded to account for anatomical variability. The length of the cartilages was compared between the PE and control subjects using the independent-samples t test. For patients with asymmetric PE the length of the 4th-7th costal cartilages was compared between the rotated and nonrotated sides. Results: The mean transverse and coronal thorax diameters were 233.29 ± 24.47 and 231.69 ± 22.47 mm for PE patients and 252.67 ± 37.25 and 238.64 ± 27.40 mm for controls, respectively, with no significant differences between the two groups (p = 0.816 and 0.145). The mean sagittal diameter (59.30 ± 14.21 mm) and Haller index (4.02 ± 1.34) in the PE group were significantly different from the controls (107.34 ± 19.59 and 2.2 ± 0.54 mm, respectively; p = 0.00). Actual and relative lengths of costal cartilages were similar in both PE subjects and controls for all 4 costal cartilages measured. In subjects with asymmetric PE, both relative and absolute costal cartilage lengths were similar on the rotated and nonrotated side. Conclusions: The length of the 4th, 5th, 6th and 7th costal cartilages was similar in PE patients and the control subjects. These was also similar between the rotated and nonrotated sides of the sternum in patients with asymmetric PE.
The purpose of this study was to determine whether or not patients with pectus excavatum (PE) exhibit costal cartilage overgrowth compared to normal subjects.OBJECTIVEThe purpose of this study was to determine whether or not patients with pectus excavatum (PE) exhibit costal cartilage overgrowth compared to normal subjects.The computed tomography acquisitions of 32 patients with PE and 35 normal controls were analyzed. On axial images the length of the 4th-7th costal cartilages was measured to calculate the Haller index. The ratio between the length of the cartilages and the median of the transverse and longitudinal thorax diameters were recorded to account for anatomical variability. The length of the cartilages was compared between the PE and control subjects using the independent-samples t test. For patients with asymmetric PE the length of the 4th-7th costal cartilages was compared between the rotated and nonrotated sides.MATERIALS AND METHODSThe computed tomography acquisitions of 32 patients with PE and 35 normal controls were analyzed. On axial images the length of the 4th-7th costal cartilages was measured to calculate the Haller index. The ratio between the length of the cartilages and the median of the transverse and longitudinal thorax diameters were recorded to account for anatomical variability. The length of the cartilages was compared between the PE and control subjects using the independent-samples t test. For patients with asymmetric PE the length of the 4th-7th costal cartilages was compared between the rotated and nonrotated sides.The mean transverse and coronal thorax diameters were 233.29 ± 24.47 and 231.69 ± 22.47 mm for PE patients and 252.67 ± 37.25 and 238.64 ± 27.40 mm for controls, respectively, with no significant differences between the two groups (p = 0.816 and 0.145). The mean sagittal diameter (59.30 ± 14.21 mm) and Haller index (4.02 ± 1.34) in the PE group were significantly different from the controls (107.34 ± 19.59 and 2.2 ± 0.54 mm, respectively; p = 0.00). Actual and relative lengths of costal cartilages were similar in both PE subjects and controls for all 4 costal cartilages measured. In subjects with asymmetric PE, both relative and absolute costal cartilage lengths were similar on the rotated and nonrotated side.RESULTSThe mean transverse and coronal thorax diameters were 233.29 ± 24.47 and 231.69 ± 22.47 mm for PE patients and 252.67 ± 37.25 and 238.64 ± 27.40 mm for controls, respectively, with no significant differences between the two groups (p = 0.816 and 0.145). The mean sagittal diameter (59.30 ± 14.21 mm) and Haller index (4.02 ± 1.34) in the PE group were significantly different from the controls (107.34 ± 19.59 and 2.2 ± 0.54 mm, respectively; p = 0.00). Actual and relative lengths of costal cartilages were similar in both PE subjects and controls for all 4 costal cartilages measured. In subjects with asymmetric PE, both relative and absolute costal cartilage lengths were similar on the rotated and nonrotated side.The length of the 4th, 5th, 6th and 7th costal cartilages was similar in PE patients and the control subjects. These was also similar between the rotated and nonrotated sides of the sternum in patients with asymmetric PE.CONCLUSIONSThe length of the 4th, 5th, 6th and 7th costal cartilages was similar in PE patients and the control subjects. These was also similar between the rotated and nonrotated sides of the sternum in patients with asymmetric PE.
The purpose of this study was to determine whether or not patients with pectus excavatum (PE) exhibit costal cartilage overgrowth compared to normal subjects. The computed tomography acquisitions of 32 patients with PE and 35 normal controls were analyzed. On axial images the length of the 4th-7th costal cartilages was measured to calculate the Haller index. The ratio between the length of the cartilages and the median of the transverse and longitudinal thorax diameters were recorded to account for anatomical variability. The length of the cartilages was compared between the PE and control subjects using the independent-samples t test. For patients with asymmetric PE the length of the 4th-7th costal cartilages was compared between the rotated and nonrotated sides. The mean transverse and coronal thorax diameters were 233.29 ± 24.47 and 231.69 ± 22.47 mm for PE patients and 252.67 ± 37.25 and 238.64 ± 27.40 mm for controls, respectively, with no significant differences between the two groups (p = 0.816 and 0.145). The mean sagittal diameter (59.30 ± 14.21 mm) and Haller index (4.02 ± 1.34) in the PE group were significantly different from the controls (107.34 ± 19.59 and 2.2 ± 0.54 mm, respectively; p = 0.00). Actual and relative lengths of costal cartilages were similar in both PE subjects and controls for all 4 costal cartilages measured. In subjects with asymmetric PE, both relative and absolute costal cartilage lengths were similar on the rotated and nonrotated side. The length of the 4th, 5th, 6th and 7th costal cartilages was similar in PE patients and the control subjects. These was also similar between the rotated and nonrotated sides of the sternum in patients with asymmetric PE.
Author Burlacu, Ovidiu
David, Vlad-Laurentiu
Cerbu, Simona
Stanciulescu, Corina-Maria
Boia, Eugen-Sorin
Haragus, Horia
Cozma, Gabriel
Popoiu, Marius-Calin
AuthorAffiliation b First Clinic of Orthopedics and Trauma, University of Medicine and Pharmacy, Timisoara, Romania
c Department of Thoracic Surgery, ‘Victor Babes’ University of Medicine and Pharmacy, Timisoara, Romania
a Department of Pediatric Surgery, University of Medicine and Pharmacy, Timisoara, Romania
d Department of Imagistics, Emergency Children's Hospital ‘Louis Turcanu’, Timisoara, Romania
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Cites_doi 10.1097/00000658-194406000-00012
10.1053/j.sempedsurg.2008.03.002
10.1053/j.semtcvs.2009.03.001
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10.1093/icvts/ivt392
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10.1016/j.jpedsurg.2014.02.044
10.1093/icvts/ivt321
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Issue 6
Keywords Costal cartilage
Pectus excavatum
Overgrowth
Cartilage length
Language English
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References Feng J, Hu T, Liu W, et al: The biomechanical, morphologic, and histochemical properties of the costal cartilages in children with pectus excavatum. J Pediatr Surg 2001;36:1770-1776.1173390410.1053/jpsu.2001.28820
Fokin AA, Steuerwald NM, Ahrens WA, et al: Anatomical, histologic, and genetic characteristics of congenital chest wall deformities. Semin Thorac Cardiovasc Surg 2009;21:44-57.1963256310.1053/j.semtcvs.2009.03.001
Nakaoka T, Uemura S, Yoshida T, et al: Overgrowth of costal cartilage is not the etiology of pectus excavatum. J Pediatr Surg 2010;45:2015-2018.2092072110.1016/j.jpedsurg.2010.04.018
Park CH, Kim TH, Haam SJ, et al: The etiology of pectus carinatum involves overgrowth of costal cartilage and undergrowth of ribs. J Pediatr Surg 2014;49:1252-1258.2509208510.1016/j.jpedsurg.2014.02.044
Sweet RH: Pectus excavatum. Ann Surg 1944;119:922-934.1785841910.1097/00000658-194406000-00012
Cubuk S, Yucel O: eComment: dilemma of the costal cartilage overgrowth in chest wall deformities. Interact Cardiovasc Thorac Surg 2013;17:763.2415004610.1093/icvts/ivt401
Kelly RE Jr: Pectus excavatum: historical background, clinical picture, preoperative evaluation and criteria for operation. Semin Pediatr Surg 2008;17:181-193.1858282410.1053/j.sempedsurg.2008.03.002
Benhamed L, Hysi I, Wurtz AJ: eComment: is overgrowth of costal cartilages the unique cause of pectus deformities? Interact Cardiovasc Thorac Surg 2013;17:763.2415004510.1093/icvts/ivt392
Park CH, Kim TH, Haam SJ, et al: Does overgrowth of costal cartilage cause pectus carinatum? A three-dimensional computed tomography evaluation of rib length and costal cartilage length in patients with asymmetric pectus carinatum. Interact Cardiovasc Thorac Surg 2013;17:757-763.2386860410.1093/icvts/ivt321
Nakaoka T, Uemura S, Yano T, et al: Does overgrowth of costal cartilage cause pectus excavatum? A study on the lengths of ribs and costal cartilages in asymmetric patients. J Pediatr Surg 2009 ;44:1333-1336.1957365710.1016/j.jpedsurg.2008.09.023
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19573657 - J Pediatr Surg. 2009 Jul;44(7):1333-6
25092085 - J Pediatr Surg. 2014 Aug;49(8):1252-8
17858419 - Ann Surg. 1944 Jun;119(6):922-34
11733904 - J Pediatr Surg. 2001 Dec;36(12):1770-6
18582824 - Semin Pediatr Surg. 2008 Aug;17(3):181-93
24150045 - Interact Cardiovasc Thorac Surg. 2013 Nov;17 (5):763
20920721 - J Pediatr Surg. 2010 Oct;45(10 ):2015-8
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19632563 - Semin Thorac Cardiovasc Surg. 2009 Spring;21(1):44-57
References_xml – reference: Nakaoka T, Uemura S, Yano T, et al: Does overgrowth of costal cartilage cause pectus excavatum? A study on the lengths of ribs and costal cartilages in asymmetric patients. J Pediatr Surg 2009 ;44:1333-1336.1957365710.1016/j.jpedsurg.2008.09.023
– reference: Sweet RH: Pectus excavatum. Ann Surg 1944;119:922-934.1785841910.1097/00000658-194406000-00012
– reference: Nakaoka T, Uemura S, Yoshida T, et al: Overgrowth of costal cartilage is not the etiology of pectus excavatum. J Pediatr Surg 2010;45:2015-2018.2092072110.1016/j.jpedsurg.2010.04.018
– reference: Park CH, Kim TH, Haam SJ, et al: The etiology of pectus carinatum involves overgrowth of costal cartilage and undergrowth of ribs. J Pediatr Surg 2014;49:1252-1258.2509208510.1016/j.jpedsurg.2014.02.044
– reference: Benhamed L, Hysi I, Wurtz AJ: eComment: is overgrowth of costal cartilages the unique cause of pectus deformities? Interact Cardiovasc Thorac Surg 2013;17:763.2415004510.1093/icvts/ivt392
– reference: Feng J, Hu T, Liu W, et al: The biomechanical, morphologic, and histochemical properties of the costal cartilages in children with pectus excavatum. J Pediatr Surg 2001;36:1770-1776.1173390410.1053/jpsu.2001.28820
– reference: Kelly RE Jr: Pectus excavatum: historical background, clinical picture, preoperative evaluation and criteria for operation. Semin Pediatr Surg 2008;17:181-193.1858282410.1053/j.sempedsurg.2008.03.002
– reference: Cubuk S, Yucel O: eComment: dilemma of the costal cartilage overgrowth in chest wall deformities. Interact Cardiovasc Thorac Surg 2013;17:763.2415004610.1093/icvts/ivt401
– reference: Fokin AA, Steuerwald NM, Ahrens WA, et al: Anatomical, histologic, and genetic characteristics of congenital chest wall deformities. Semin Thorac Cardiovasc Surg 2009;21:44-57.1963256310.1053/j.semtcvs.2009.03.001
– reference: Park CH, Kim TH, Haam SJ, et al: Does overgrowth of costal cartilage cause pectus carinatum? A three-dimensional computed tomography evaluation of rib length and costal cartilage length in patients with asymmetric pectus carinatum. Interact Cardiovasc Thorac Surg 2013;17:757-763.2386860410.1093/icvts/ivt321
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  doi: 10.1097/00000658-194406000-00012
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  doi: 10.1053/j.sempedsurg.2008.03.002
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  doi: 10.1016/j.jpedsurg.2010.04.018
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– reference: 19573657 - J Pediatr Surg. 2009 Jul;44(7):1333-6
– reference: 24150046 - Interact Cardiovasc Thorac Surg. 2013 Nov;17 (5):763
– reference: 24150045 - Interact Cardiovasc Thorac Surg. 2013 Nov;17 (5):763
– reference: 11733904 - J Pediatr Surg. 2001 Dec;36(12):1770-6
– reference: 17858419 - Ann Surg. 1944 Jun;119(6):922-34
– reference: 23868604 - Interact Cardiovasc Thorac Surg. 2013 Nov;17 (5):757-63
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– reference: 18582824 - Semin Pediatr Surg. 2008 Aug;17(3):181-93
– reference: 19632563 - Semin Thorac Cardiovasc Surg. 2009 Spring;21(1):44-57
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Snippet Objective: The purpose of this study was to determine whether or not patients with pectus excavatum (PE) exhibit costal cartilage overgrowth compared to normal...
The purpose of this study was to determine whether or not patients with pectus excavatum (PE) exhibit costal cartilage overgrowth compared to normal subjects....
The purpose of this study was to determine whether or not patients with pectus excavatum (PE) exhibit costal cartilage overgrowth compared to normal...
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StartPage 533
SubjectTerms Adolescent
Adult
Case-Control Studies
Child
Costal Cartilage - physiology
Female
Funnel Chest - diagnostic imaging
Funnel Chest - physiopathology
Humans
Male
Original Paper
Tomography Scanners, X-Ray Computed
Young Adult
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Title Costal Cartilages Do Not Overgrow in Patients with Pectus Excavatum
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