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Swimmers and pectus excavatum

icanis

Synonym(s): Swimmer, funnel chest, PE


Introduction

  • The two most common malformations of the chest are pectus excavatum ("funnel chest") and flat chest.
  • Pectus excavatum is a congenital malformation of the sternum and costochondral cartilages causing narrowing of the chest ventrodorsally and inversion of the sternum. These skeletal malformations can lead to compression of thoracic organs and may reduce pulmonary and cardiac function.
  • In flat chested animals, the ribcage angles sharply at the costochondral junction and the chest is flattened ventrally.
  • Pectus excavatum and flat chest may very well be an expression of the same disease with flat chest being a less severe form of PE.

Pathogenesis

Etiology

  • Congenital.

Predisposing factors

General
  • Many theories have been proposed as to the cause of flat chests in humans and animals including genetic, nutritional and environmental factors but no definitive cause has been identified.
  • Suggested causes of pectus excavatum include congenital predisposition, abnormal intra-uterine pressure, abnormal ligament development (ie shortened central diaphragmatic tendon or thickened substernal ligament), abnormal osteogenesis and chondrogenesis.
  • May also occur secondary to upper respiratory obstruction (as a result of increased negative intrathoracic pressure), environmental factors, and posturing difficulties.

Pathophysiology

  • Weakness of costochondral muscles and diaphragm.
  • Expansion of lungs is poor.
  • Role of exaggerated negative intrathoracic pressure supported by the over-representation of pectus excavatum in brachycephalic breeds.

Timecourse

  • Usually apparent within 10 days of birth.
  • Flat chests in mildly affected animals can often resolve spontaneously, sometimes to the point where it is hard to detect the abnormality in the adult.
  • Pectus excavatum will not resolve spontaneously and can progress.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Verhoeven G et al (2006) Swimmer syndrome in a Devon rex kitten and an English bulldog puppy. JSAP 47 (10), 615-619 PubMed.
  • Ellison G, Halling K B (2004) Atypical pectus excavatum in two Welsh terrier littermates. JSAP 45 (6), 311-314 PubMed.
  • Boudrieau R et al (1990) Pectus excavatum in dogs and cats. Comp Contin Edu Pract Vet 12 (3), 341-355 VetMedResource.
  • Fossum T W, Boudrieau R, Hobson H P (1989) Pectus excavatum in eight dogs and six cats. J Am Anim Hosp Assoc 25 (5), 595-605 VetMedResource.

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