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Progressive chest pain
  • Two year history of chest pain
  • Occurs only when patient lies on right side
  • Physical findings limited to marked pectus excavatum

What might cause this problem?
  • What diagnostic test would be most helpful?
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ECG obtained while patient lying on right side and while supine
  • What is wrong with the ECG?
    • ECG while patient lying on right side is shown
    • When supine, ECG normalized
  • What is wrong with the CT scan?
  • What is wrong with the Coronary angiogram?
    • Upper angiogram was obtained with patient supine
    • Lower angiogram was obtained with patient on right side
  • What might be done to fix the problem?
Image is on publisher's web site and may require subscription to view. Click Circulation.1998;98:605 to view article. Click image to enlarge/reduce size.

 

 
Disclaimer: Content here is for discussion and review. If you need medical attention, consult your health care provider. If you prescribe diagnostic tests or treatment, consult standard references before prescribing those you are not familiar with.
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Findings
  • CT scan shows pectus deformity with sternum in close contact with ascending aorta
  • ECG shows inferior ST segment elevation
  • Coronary angiogram shows proximal compression of right coronary artery when patient is rotated onto right side
  • Angina was eliminated after surgical repair of chest deformity
  • A similar case has been reported in a patient with pectus excavatum and straight back - Am J Cardiol.1968 Mar;21:446.
Disclaimer: Content here is for discussion and review. If you need medical attention, consult your health care provider. If you prescribe diagnostic tests or treatment, consult standard references before prescribing those you are not familiar with.
Send comments to Donald Vine MD

Four
 
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Five
 
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