SHM Converge Scientific Abstract ePoster Gallery-Severe Pectus Excavatum: A Rare and Abrupt Presentation in Adulthood

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This case report highlights that <strong>pectus excavatum, even when asymptomatic earlier in life, can become clinically significant in adulthood</strong>. The patient developed <strong>exertional dyspnea, chest pain, palpitations, and near-syncope/syncope-like symptoms</strong>, prompting evaluation for cardiopulmonary causes.

Initial workup included <strong>telemetry monitoring</strong>, <strong>metoprolol tartrate</strong>, and testing to exclude other conditions. Labs such as <strong>thyroid, liver panel, ESR/CRP, AM cortisol, and D-dimer</strong> were normal. A <strong>Marfan systemic score of 2</strong> made a genetic workup unnecessary. <strong>Pulmonary function tests</strong> later showed a <strong>mild restrictive ventilatory defect</strong>, supporting the chest wall deformity as a contributor to symptoms.

Given the symptomatic pectus excavatum, <strong>thoracic surgery was consulted</strong>, and surgical correction was recommended. The patient was discharged with <strong>home oxygen</strong>, <strong>metoprolol</strong>, and a <strong>48-hour Holter monitor</strong>. Five months later, she underwent a successful <strong>Nuss procedure</strong>, in which a metal bar was placed beneath the rib cage to reshape the chest wall.

At follow-up two weeks after surgery, her <strong>dyspnea on exertion had improved significantly</strong>. She no longer required home oxygen, <strong>metoprolol was stopped</strong>, and her symptoms did not recur.

The report concludes that:
- <strong>Pectus excavatum can cause exertional dyspnea, chest pain, palpitations, and rarely syncope</strong>
- Symptomatic patients should initially be evaluated with <strong>CT chest, echocardiogram, pulmonary function tests, and exercise testing</strong>
- Patients who become symptomatic later in life can still have <strong>successful surgical repair in adulthood</strong>

Asset Subtitle

Emily Xiao

Meta Tag

Author List Doris Lin, Emily Xiao, Niraj Mehta, Savannah M. Bowman

Category Clinical Vignettes

Concept Pectus Excavatum

Concept Exertional Dyspnea

Concept Chest Pain

Concept Nuss Procedure

Concept Palpitations

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Emily Xiao

Track Adult

Keywords

pectus excavatum

adult presentation

exertional dyspnea

chest pain

palpitations

syncope

pulmonary function tests

Nuss procedure

thoracic surgery

surgical repair

Pectus Excavatum

Exertional Dyspnea

Chest Pain

Nuss Procedure

Palpitations