A16-YEAR-OLD BOY WITH NO MEDICAL OR SURGICAL HISTORY WAS HOSPITALIZED FOR EVALUATION OF A congenital deformity of the anterior chest wall. The physical examination revealed substantial anterior sternal depression. The results of routine laboratory tests were normal. Posteroanterior chest radiography revealed obscuration of the right heart border and displacement of the cardiomediastinal silhouette to the left (Panel A). Lateral chest radiography showed marked sternal depression (Panel B). Chest computed tomography showed a pectus index (ratio of the width to the depth of the chest wall) of more than 3.25 (normal range, 2.0 to 3.0) (Panel C). The patient received a diagnosis of funnel chest, a severe variation of pectus excavatum deformity. Patients with funnel chest are usually asymptomatic but can have related cardiovascular dysfunction, thoracolumbar scoliosis, or psychological effects. A pectus index of more than 3.25 is classified as severe funnel chest and may indicate a benefit from surgical intervention. The patient underwent a Nuss procedure (in which a bar is inserted under the sternum) and had good postoperative recovery without complications.
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