Presyncope in a Patient Status Post Pectus Excavatum Repair

Figures & data

Figure 1 Status post remote pectus excavatum (PEX) repair twenty-two years ago.

Notes: (A) Full front aspect of PEX repair. (B) Oblique visualization of PEX repair.

Figure 2 The patient’s 12-lead electrocardiogram (ECG) displaying sinus rhythm with right bundle branch block (RBBB) and left anterior fascicular block (LAFB).

Figure 3 The patient’s chest radiography.

Notes: (A) Posterior-anterior (PA) view indicating the relatively narrow cardiac silhouette and right hilar “haziness” mimicking either pulmonary edema or pneumonia. (B) Lateral view indicating the proximity of the right ventricular aspect of the heart to the sternum.

Figure 4 The patient’s cardiac computed tomography angiogram (cCTA).

Notes: (A) Axial view of the sternum impinging on the right ventricular free wall demarcated by the red arrow. (B) Axial view of the sternum impinging on the right infundibular outflow tract demarcated by the red arrow.

Figure 5 The patient’s cardiac computed tomography angiogram (cCTA) demonstrating a relatively severe Haller index of 5.2 indicated by the ratio of the transverse diameter (the horizontal distance of the inside of the rib cage) and the anteroposterior diameter (the shortest distance between the vertebrae and sternum).

Figure 6 The patient’s cardiac computed tomography angiogram (cCTA) demonstrates the slit-like ostial right coronary artery compression or vasospasm between the green arrows.