Growth disturbance of the sternum and pectus deformities: imaging studies and clinical correlation

Background. Radiologic reports of "normal" chest are not uncommon when there clearly are irregularities of sternal ossification and maturation. Analysis of imaging studies of sternal deformities for growth disturbances is not common in the literature and is addressed in this manuscript. Objective. To determine the influence of sternal growth on development of pectus deformities and correlate imaging studies with clinical aspects of different types of these deformities. Material and methods. One hundred forty-one children and adolescents with pectus deformities were evaluated. Sternal growth was estimated through the development of radiographic indices that were available for 57 patients with pectus deformities and for 71 controls. Magnetic resonance imaging of the sternum was performed in two patients to correlate with radiographic information. Results. Radiographic indices of the sternum suggested growth disturbances in three basic types of pectus carinatum deformities: superior, inferior and lateral, and in the localized type of pectus excavatum. Conclusion. Sternal growth seems to have an important influence on the development of carinatum superior; partial influence on carinatum inferior, carinatum lateral, and excavatum localized; and no influence on excavatum wide pectus deformities. The endochondral growth of the sternum and costal arches is an important concept that aids in the interpretation of imaging studies and the orthopedic approach to management of these deformities in children and adolescents.