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The medial breast margin sign: A new sign of pectus excavatum in adult females and comparison with classic signs.

Abstract

INTRODUCTION

Pectus excavatum (PX) denotes a concavity of the sternum and is the most common chest wall deformity. Many characteristic signs have been described on frontal chest radiographs including increased density of the inferomedial right lung, blurring of the right heart border, steeply angled anterior ribs, horizontal posterior ribs, straight or convex left heart border and loss of silhouette of the descending thoracic aorta. These signs are often subtle and rarely all present in any individual. We describe a further sign in women with PX, the medial breast margin sign. This sign consists of more sharply defined and more vertically oriented medial breast borders on frontal chest radiographs than in those of women with normal chest wall morphology. This study aims to document the sensitivity, specificity and inter-observer reliability of the new sign, and compare with that of the previously described signs in patients with varying degrees of PX.

METHODS

The frontal chest radiographs of 185 women with PX and 50 women with normal chest wall morphology were assessed by two reviewers for the presence of the new sign and previously described signs. All the signs had their sensitivity, specificity and inter-observer reliability calculated.

RESULTS

The new sign had a sensitivity of 0.48, a specificity of 0.96 and inter-observer reliability of κ = 0.79, ranking third, second and first among all other signs, respectively.

CONCLUSION

The medial breast margin sign is useful in diagnosing PX and is comparable to the previously described classic signs.

Authors+Show Affiliations

Department of Radiology, Christchurch Hospital, Christchurch, New Zealand.Everlight Radiology, Sydney, New South Wales, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31535457

Citation

Hapuarachchi, Kamal S., and Ian A. Cowan. "The Medial Breast Margin Sign: a New Sign of Pectus Excavatum in Adult Females and Comparison With Classic Signs." Journal of Medical Imaging and Radiation Oncology, 2019.
Hapuarachchi KS, Cowan IA. The medial breast margin sign: A new sign of pectus excavatum in adult females and comparison with classic signs. J Med Imaging Radiat Oncol. 2019.
Hapuarachchi, K. S., & Cowan, I. A. (2019). The medial breast margin sign: A new sign of pectus excavatum in adult females and comparison with classic signs. Journal of Medical Imaging and Radiation Oncology, doi:10.1111/1754-9485.12949.
Hapuarachchi KS, Cowan IA. The Medial Breast Margin Sign: a New Sign of Pectus Excavatum in Adult Females and Comparison With Classic Signs. J Med Imaging Radiat Oncol. 2019 Sep 18; PubMed PMID: 31535457.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The medial breast margin sign: A new sign of pectus excavatum in adult females and comparison with classic signs. AU - Hapuarachchi,Kamal S, AU - Cowan,Ian A, Y1 - 2019/09/18/ PY - 2019/05/19/received PY - 2019/08/06/revised PY - 2019/08/12/accepted PY - 2019/9/20/entrez KW - funnel chest KW - medial breast margin sign KW - pectus excavatum KW - pectus excavatum on frontal chest radiographs KW - radiological signs of pectus excavatum JF - Journal of medical imaging and radiation oncology JO - J Med Imaging Radiat Oncol N2 - INTRODUCTION: Pectus excavatum (PX) denotes a concavity of the sternum and is the most common chest wall deformity. Many characteristic signs have been described on frontal chest radiographs including increased density of the inferomedial right lung, blurring of the right heart border, steeply angled anterior ribs, horizontal posterior ribs, straight or convex left heart border and loss of silhouette of the descending thoracic aorta. These signs are often subtle and rarely all present in any individual. We describe a further sign in women with PX, the medial breast margin sign. This sign consists of more sharply defined and more vertically oriented medial breast borders on frontal chest radiographs than in those of women with normal chest wall morphology. This study aims to document the sensitivity, specificity and inter-observer reliability of the new sign, and compare with that of the previously described signs in patients with varying degrees of PX. METHODS: The frontal chest radiographs of 185 women with PX and 50 women with normal chest wall morphology were assessed by two reviewers for the presence of the new sign and previously described signs. All the signs had their sensitivity, specificity and inter-observer reliability calculated. RESULTS: The new sign had a sensitivity of 0.48, a specificity of 0.96 and inter-observer reliability of κ = 0.79, ranking third, second and first among all other signs, respectively. CONCLUSION: The medial breast margin sign is useful in diagnosing PX and is comparable to the previously described classic signs. SN - 1754-9485 UR - https://www.unboundmedicine.com/medline/citation/31535457/The_medial_breast_margin_sign:_A_new_sign_of_pectus_excavatum_in_adult_females_and_comparison_with_classic_signs L2 - https://doi.org/10.1111/1754-9485.12949 DB - PRIME DP - Unbound Medicine ER -