Indications for surgical treatment of funnel chest by chest radiograph

Area of Science:

• Pediatric Surgery
• Thoracic Surgery
• Medical Imaging

Background:

• Funnel chest (FC), a common chest wall deformity in children, requires objective criteria for surgical treatment indication.
• Existing methods for assessing FC severity lack standardized quantitative measures.
• Age-related changes in chest morphology indices are crucial for accurate FC assessment.

Purpose of the Study:

• To establish reliable indications for surgical treatment in pediatric funnel chest (FC) patients.
• To evaluate the utility of the vertebral index (VI) and frontosagittal index (FSI) in assessing FC severity.
• To correlate pre- and post-operative VI and FSI values with clinical outcomes.

Main Methods:

• Comparative analysis of VI and FSI in 47 children with FC (pre- and post-surgery) and 210 age-matched normal children.
• Measurement of VI and FSI using standardized radiological assessments.
• Statistical analysis to determine significant differences and correlations between indices and age groups.

Main Results:

• Normal children exhibit a consistent age-related increase in VI and decrease in FSI, with significant changes around age 3.
• FC patients showed significant improvement in VI and FSI post-sternal elevation surgery, yet remained outside normal ranges.
• A strong correlation was observed between VI and FSI in both normal and FC patients, both pre- and post-operatively.

Conclusions:

• A vertebral index (VI) exceeding 27 and/or a frontosagittal index (FSI) below 29 are proposed as indications for surgical treatment in funnel chest (FC).
• These indices, derived from normal pediatric populations, correlate with patient-reported disturbances, guiding surgical decisions.
• While VI and FSI are valuable, postoperative assessment may be influenced by residual chest flatness, necessitating careful interpretation.