Pectus excavatum (funnel chest) is a congenital chest wall deformity characterised by concave depression of the sternum. Compression of the heart causes characteristic findings on frontal CXR of an indistinct right heart border, decreased heart density and displacement of the heart to the left. The anterior ribs have an accentuated downward slope so that the ribs appear heart-shaped. The indistinct right heart border can mimic right middle lobe pathology but a lateral CXR confirms the sternal deformity. Surgical repair is performed in severe cases. Pectus excavatum is usually an isolated anomaly but can be associated with Marfan’s syndrome, Noonan’s syndrome, fetal alcohol syndrome and homocystinuria.

Reference: Dahnert W. Radiology Review Manual, 5th edition. Lippincott, Williams and Wilkins 2003

Credit: Dr Donna D’Souza