Haihua Gu1, Guanxin Xu1, Tianshu Liu1, Sai Zhang2. 1. Department of Thoracic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88, Hangzhou, 310009, Zhejiang, People's Republic of China. 2. Department of Thoracic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88, Hangzhou, 310009, Zhejiang, People's Republic of China. zhangsai@zju.edu.cn.
Abstract
BACKGROUND: The Nuss bar is commonly used for minimally invasive correction of pectus excavatum and is usually removed within 2-3 years. Here, we report a case of 10-year bar placement after the Nuss procedure accompanied by unique complications of thoracic malformation that have not been described before. The asymmetric pectus carinatum caused by bar displacement and significant rib periosteal hyperplasia is described for the first time. CASE PRESENTATION: A 23-year-old man was admitted to our hospital due to the main complaint of obvious chest discomfort when lifting heavy weights. The bar removal was seriously delayed due to his loss to follow-up. Chest asymmetry and distant heart sounds were found during a physical examination. A chest CT scan demonstrated that the right end of the lower bar originally fixed outside the ribs had shifted into the thoracic cavity, and the left costal cartilage was obviously protruding. Additionally, the displaced bars were separated from the sternum and tightly attached to the pericardium, resulting in abnormalities of the anterior mediastinum. These secondary thoracic deformities made the patient extremely prone to massive hemorrhage or multiple rib fractures when sliding the bars out. However, serious consequences were avoided due to reasonable adjustments to the usual bar removal procedures. CONCLUSION: This case demonstrates a specific type of bar displacement caused by prolonged placement of the bars and highlights the importance of rigorous follow-up of patients after the Nuss procedure.
BACKGROUND: The Nuss bar is commonly used for minimally invasive correction of pectus excavatum and is usually removed within 2-3 years. Here, we report a case of 10-year bar placement after the Nuss procedure accompanied by unique complications of thoracic malformation that have not been described before. The asymmetric pectus carinatum caused by bar displacement and significant rib periosteal hyperplasia is described for the first time. CASE PRESENTATION: A 23-year-old man was admitted to our hospital due to the main complaint of obvious chest discomfort when lifting heavy weights. The bar removal was seriously delayed due to his loss to follow-up. Chest asymmetry and distant heart sounds were found during a physical examination. A chest CT scan demonstrated that the right end of the lower bar originally fixed outside the ribs had shifted into the thoracic cavity, and the left costal cartilage was obviously protruding. Additionally, the displaced bars were separated from the sternum and tightly attached to the pericardium, resulting in abnormalities of the anterior mediastinum. These secondary thoracic deformities made the patient extremely prone to massive hemorrhage or multiple rib fractures when sliding the bars out. However, serious consequences were avoided due to reasonable adjustments to the usual bar removal procedures. CONCLUSION: This case demonstrates a specific type of bar displacement caused by prolonged placement of the bars and highlights the importance of rigorous follow-up of patients after the Nuss procedure.
Authors: David M Notrica; Lisa E McMahon; Kevin N Johnson; Daniel A Velez; Leigh C McGill; Dawn E Jaroszewski Journal: Ann Thorac Surg Date: 2014-09 Impact factor: 4.330