PECTUS EXCAVATUM - ABNORMAL EXERCISE SCINTIGRAPHY WITH NORMAL CORONARY-ARTERIES

Pectus excavatum is the most common congenital abnormality of the ches t 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 positi ve stress radionuclide ventriculogram (RVG) and SPECT scintigraphic st udies may be significantly reduced in patients with moderate to severe forms of this abnormality. Our findings also suggest, however, that e ither lateral or even a shallow left posterior oblique detector positi oning during RVG, a significantly revised SPECT acquisition orbit, or planar imaging may provide a more accurate means to assess possible CA D in these patients. Likewise, physician input would appear to be inva luable in determining the optimal mode of imaging and the acquisition protocol for patients with pectus excavatum.