Comprehensive assessment of pectus excavatum: analyzing chest wall anatomy, cardiac rotation, and severity classification for enhanced diagnosis and treatment.

Pectus excavatum (PE) is the most common congenital chest wall deformity, characterized by a depression of the anterior chest wall which may compromise cardiac function and cause symptoms like exercise intolerance, chest pain, and shortness of breath. While diagnosis is often based on appearance, imaging-based metrics provide objective severity assessment. This study evaluated associations between PE severity indices and cardiac rotation angle in 37 adolescents generated two sex-specific anatomical models of severe cases for future diagnostic and treatment planning. Chest computed tomography (CT) scans of 30 male and seven female PE patients aged 12-16 years were analyzed to measure the Haller index, Correction index, and cardiac rotation angle. Severity by Haller index was classified as mild (2.0-3.2 cm,n= 15), moderate (3.2-3.5 cm,n= 7), or severe (>3.5 cm,n= 15). Cardiac rotation angle increased with severity (p= 0.001): mild (37.6 ± 13.1°), moderate (44.8 ± 13.6°), and severe (51 ± 13.2°). Cardiac rotation angle was positively associated with the Haller index (R2= 0.24,p= 0.002), but not the Correction index (R2= 0.01,p= 0.55). CT scans of a representative male and female were segmented to generate 3D models of thoracic and abdominal structures. These measurements and models may inform diagnostic criteria, treatment planning, and personalized device development for adolescents with PE.