Prevalence of Pectus Excavatum in an Adult Population-Based Cohort Estimated from Radiographic Indices of Chest Wall Shape

Purpose: Pectus excavatum is the most common chest wall skeletal deformity. Although commonly evaluated in adolescence, its prevalence in adults is unknown. Methods: Radiographic indices of chest wall shape were analyzed for adult participants of the first (n=2687) and second (n=1780) Dallas Heart Study and compared to pectus cases (n=297). Thoracic computed tomography imaging studies were examined to calculate the Haller index, a measure of thoracic axial shape, and the Correction index, which quantitates the posterior displacement of the sternum relative to the ribs. Results: At the level of the superior xiphoid, 0.5%, 5% and 0.4% of adult Dallas Heart Study subjects have evidence of pectus excavatum using thresholds of Haller Index >3.25, Correction Index >10%, or both, respectively. There is a greater prevalence of pectus in women than men. In the general population, the Haller and Correction Indices are associated with height and weight, independent of age, gender, and ethnicity. Repeat imaging of a subset of subjects (n=992) demonstrated decreases in the mean Haller and Correction Indices over seven years, suggesting development of a more circular axial thorax and with less sternal depression. Conclusions: In this study, we estimate the prevalence of pectus excavatum at 0.4% or 1 in 25 individuals in a large, population-based, multi-ethnic adult population with a mean age of 44 years old. To our knowledge, this is the first population-based study estimating the prevalence of pectus in adults.