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Pectus Excavatum: Abnormal Exercise Scintigraphy with Normal Coronary Arteries

Cardiovascular Division, Department of Medicine and the Nuclear Medicine Division, Department of Radiology, University of Minnesota Medical School, Minneapolis, Minnesota

Correspondence: For correspondence and reprints contact: George C. Haidet, MD, Cardiovascular Division, Dept. of Medicine, University of Minnesota Medical School, Box 508 UMHC, 420 Delaware St. SE, Minneapolis, MN 55455.

ABSTRACT

Pectus excavatum is the most common congenital abnormality of the chest wall, and is frequently associated with chest pain. The invasive, as well as the ECG and echocardiographic assessment of possible coronary artery disease (CAD) in adults with moderate to severe forms of this deformity, is often complicated by the associated displacement of the heart in the chest cavity in these patients. We present findings in a 67-yr-old male that demonstrate that the predictive accuracy of positive stress radionuclide ventriculogram (RVG) and SPECT scintigraphic studies may be significantly reduced in patients with moderate to severe forms of this abnormality. Our findings also suggest however, that either lateral or even a shallow left posterior oblique detector positioning during RVG, a significantly revised SPECT acquisition orbit, or planar imaging may provide a more accurate means to assess possible CAD in these patients. Likewise, physician input would appear to be invaluable in determining the optimal mode of imaging and the acquisition protocol for patients with pectus excavatum.

Key Words: pectus excavatum • coronary artery disease • radionuclide ventriculogram

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