Answer

Pectus excavatum

This chest wall deformity can simulate disease. The rib pairs are heart shaped and downward pointing in their lateral and anterior aspect. The heart is shifted to the left and superimposed soft tissue shadows at the right heart border create the impression of middle lobe disease. A lateral film will demonstrate the sternal depression and also confirm normality of the middle lobe. The CT (Fig. 1.26) demonstrates the thoracic cage deformity.

Other normal variants include cervical ribs, which are usually asymptomatic, but in a minority of cases individuals can be symptomatic with Raynauld's phenomenon. Distinction is made from normal transverse processes by the direction of slope. Cervical ribs slope downwards.

Fig. 1.26 CT pectus excavatum. Note the sternal depression and the movement of the heart to the left side.

58-year-old man.

Abdominal pain.

Patient has a drug history of corticosteroids use for polymyalgia rheumatica.

Fig. 1.27 Quiz case.

Abdominal pain.

Patient has a drug history of corticosteroids use for polymyalgia rheumatica.

58-year-old man.

(Fig. 1.27) show? ■ Does the patient need laparotomy?

Fig. 1.27 Quiz case.

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