3/21/15 1 Disorders of the Chest Wall Ramesh S. Iyer, M.D. Associate Professor Department of Radiology SeaCle Children’s Hospital University of Washington School of Medicine Disclosures • I have no financial disclosures IniJal ModaliJes • Radiographs – Usually iniJal study – Good for “big picture,” parJcularly for diffuse/global abnormaliJes • US – Great iniJal study for focal abnormaliJes, beCer for non osseous pathology – Solid vs cysJc, vascularity Restrepo R, Lee EY. Updates on imaging of chest wall lesions in pediatric paJents. Semin Roentgenol 2012 Jan; 47(1):7989.
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Disorders of the Chest Wall
Ramesh S. Iyer, M.D.
Associate Professor Department of Radiology SeaCle Children’s Hospital University of Washington
School of Medicine
Disclosures • I have no financial disclosures
IniJal ModaliJes • Radiographs
– Usually iniJal study – Good for “big picture,” parJcularly for diffuse/global abnormaliJes
• US
– Great iniJal study for focal abnormaliJes, beCer for non-‐osseous pathology
– Solid vs cysJc, vascularity Restrepo R, Lee EY. Updates on imaging of chest wall lesions in pediatric paJents. Semin Roentgenol 2012 Jan; 47(1):79-‐89.
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Secondary ModaliJes • CT
– Characterizing osseous pathology – Usually follow-‐up to XR or US – Assessing intrathoracic involvement including lungs
• MR
– Problem-‐solving modality – Great for suspected mulJcompartmental pathology – malignancy or vascular malformaJon
Restrepo R, Lee EY. Updates on imaging of chest wall lesions in pediatric paJents. Semin Roentgenol 2012 Jan; 47(1):79-‐89.
Congenital
Pectus Excavatum • Most common congenital
chest wall deformity • Posterior, mild ledward
Jlt of the sternum • Oden cosmesis, though
pain, dyspnea and restricJve lung disease possible
Koumbourlis AC. Pectus deformiJes and their impact on pulmonary physiology. Paediatr Respir Rev 2015 Jan; 16(1):18-‐24.
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Pectus Excavatum • Lateral XR – posterior Jlt of sternum
• AP – obscured right heart margin may mimic PNA
Pectus Excavatum • Low-‐dose CT with limited
slices for characterizaJon
• Haller Index: Transverse / AP • <2.6 is normal • >3.2 requires surgery
Pectus Excavatum • Typically repaired by Nuss procedure – convex retrosternal bar (Nuss bar)