Interesting case last week!

Here’s something you never want your doctor to say–interesting!  That usually means something is bad for you, but good for a teaching case.  Last week was no exception. 

 I won’t mention any names for privacy, but this teenage boy was having problems.  Everytime his lung capacity dropped below 60%, here came the steroids.  No cough, no wheeze, no attack….just steroids. What’s going on? Examination revealed the answer.  This patient has pectus excavatum (see below) that reduced his lung function because of a MECHANICAL problem, not asthma per se. 

One of many variations of pectus

The worse your deformity, the lower your lung function. The objectives and conclusion of this story are listed below.     J Pediatr. 2011 Aug;159(2):256-61.e2. Epub 2011 Mar 22.

Increasing severity of pectus excavatum is associated with reduced pulmonary function.

OBJECTIVE:

To determine whether pulmonary function decreases as a function of severity of pectus excavatum, and whether reduced function is restrictive or obstructive in nature in a large multicenter study.

CONCLUSIONS:

Among patients presenting for surgical repair of pectus excavatum, those with more severe deformities have a much higher likelihood of decreased pulmonary function with a restrictive pulmonary pattern.

Do you want pictures?  In English please!  The case report below means that if you have pectus excavatum, with any stress on the lungs (carrying weights, running, an infection) you are likely to experience a greater drop in your lung function than patients without the deformity. 

 J Med Case Reports. 2011 Dec 21;5(1):592.

Pectus on the right with lower lung function.

Objective effect manifestation of pectus excavatum on load-stressed pulmonary function testing: a case report.

CONCLUSION:

This report highlights the possible detrimental synergism of thoracic load stress and pectus excavatum on cardiopulmonary function. Thoracic load-stressed pulmonary function testing provides objective evidence in support of such a synergistic relationship.

Thus, our “mystery” patient is solved.  Because of the pectus deformity, he is more at risk for a low FEV1 with any cold or upper respiratory illness. And now you know the rest of the story….

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