Pentalogy of cantrell: A report of three cases
15
Citation
7
Reference
10
Related Paper
Citation Trend
Abstract:
Pentalogy of Cantrell is a rare upper midline syndrome that may present in association with anomalies outside the torso. The pentad - the supraumbilical body wall defect, sternal defect, deficiency of the anterior diaphragm, defect of the diaphragmatic pericardium, and the intracardiac anomalies - was first described by Cantrell et al., in 1958. The defect is said to be more common in males, and survival is dependent on the cardiac malformations and on the degree of completeness of the syndrome. We report three cases of Cantrell's pentalogy managed in our unit. Two of the patients were females and one a male. All were seen at peripheral health centers before being referred to us. Age at presentation for the girls was 18 hours and 36 hours, respectively, the boy presented at the age of six weeks. All of their parents were unschooled manual workers. All patients presented with a defect in the supraumbilical body wall, bifid sternum, and a visible cardiac impulse. We were unable to do echocardiography to rule out intracardiac anomalies in the three patients. The thin membranous covering of the epigastrium in the female patients was managed conservatively. Both female patients were discharged against medical advice as requested by their parents, due to financial constraints. The male patient was lost to follow up after two clinic visits. A multidisciplinary approach to the management of this syndrome is recommended.Keywords:
Sternum
The parasternal intercostals are the primary determinant of the inspiratory cranial displacement of the ribs in the dog. When they contract, however, these muscles also cause a caudal displacement of the sternum, presumably an expiratory motion. The present studies were designed to assess the effects of this sternal displacement on the cranial displacement of the ribs and on lung volume. Twelve supine anesthetized animals were studied. We first measured, in four paralyzed animals, the displacement of the ribs and sternum produced by known external forces applied to the ribs, the sternum, or both simultaneously. From these measurements, the elastic coupling between the ribs and sternum was determined. We then studied, in eight animals, the effect of sternal motion on rib motion and tidal volume during spontaneous breathing. Rib and sternal displacements and tidal volume were measured first with the sternum free to move caudally during inspiration and then with the sternum constrained to prevent caudal motion. Preventing the sternum from moving caudally caused a 24% increase in the inspiratory cranial displacement of the ribs; this increased displacement of the ribs agreed well with the elastic coupling between the sternum and the ribs as determined from the force-displacement observations. Tidal volume, however, remained unchanged. These observations indicate that the caudal displacement of the sternum produced by the parasternal intercostals reduces the cranial displacement of the ribs but probably increases the lateral expansion of the rib cage.
Sternum
Parasternal line
Supine position
Cite
Citations (7)
Sternum
Pectoral muscle
Pectoral girdle
Cite
Citations (2)
Sternum
Debridement (dental)
Thoracic wall
Cite
Citations (1)
The ribs are the bony framework of the thoracic cavity. Generally, there are twelve pairs of ribs. Each rib articulates posteriorly with two thoracic vertebrae; by the costovertebral joint. An exception to this rule is that the first rib articulates with the first thoracic vertebra only. According to their attachment to the sternum, the ribs are classified into three groups: true, false, and floating ribs. The true ribs are the ribs that directly articulate with the sternum with their costal cartilages; they are the first seven ribs. The false ribs are the ribs that indirectly articulate with the sternum, as their costal cartilages connect with the seventh costal cartilage; by the costochondral joint; They are the eighth, ninth, and tenth ribs. However, the floating ribs are the ribs that do not articulate with the sternum at all; they are the distal two ribs. The true ribs articulate with the sternum by the sternocostal joints. The first rib is an exception to that rule; it is a synarthrosis. Another thing that is good to know is that the first rib could uniquely articulate with the clavicle by the costoclavicular joint.
Sternum
Costal cartilage
Thorax (insect anatomy)
Cite
Citations (0)
Pectus carinatum (PC) is a chest deformity caused by a disproportionate growth of the costal cartilages compared to the bony thoracic skeleton, pulling the sternum towards, which leads to its protrusion. There has been a growing interest on using the ‘reversed Nuss’ technique as a minimally invasive procedure for PC surgical correction. A corrective bar is introduced between the skin and the thoracic cage and positioned on top of the sternum highest protrusion area for continuous pressure. Then, it is fixed to the ribs and kept implanted for about 2–3 years. The purpose of this work was to (a) assess the stresses distribution on the thoracic cage that arise from the procedure, and (b) investigate the impact of different positioning of the corrective bar along the sternum. The higher stresses were generated on the 4th, 5th and 6th ribs backend, supporting the hypothesis of pectus deformities correction-induced scoliosis. The different bar positioning originated different stresses on the ribs' backend. The bar position that led to lower stresses generated on the ribs backend was the one that also led to the smallest sternum displacement. However, this may be preferred, as the risk of induced scoliosis is lowered.
Sternum
Pectus carinatum
Bar (unit)
Cite
Citations (13)
Sternum
Thorax (insect anatomy)
Vertebral column
Costal cartilage
Shoulder girdle
Cite
Citations (0)
IN this paper we are interested in the appearance of the upper hemithorax in a film made with the subject reclining on one side. We find the upper half of the chest large, the air content increased, while the normal airless structures and all abnormal deposits are brought out to better advantage than when films are made with the body in other postures. Physiologic Considerations In the standing and the sitting postures, the human chest is in relative collapse, even during deep inspiration. This perhaps unexpected phenomenon is due to the effect of gravity on the ribs and sternum, the weights of the shoulders and the chest viscera, as well as to the soft parts suspended from the diaphragm and ribs. These weights pull the ribs and sternum downwards, i.e., they resist inspiration. Now, upon assuming the recumbent position, the chest is enlarged because the ribs and sternum rise, as they are relieved from the force of gravity (1). Measurements of the circumference of the chest show that it increases in every case upon the subject's changing from the erect to the recumbent position (2). This increase in chest capacity results in increased air content of the lung. The vital capacity is diminished (3), and the residual air increased in the recumbent position (4); i.e., the lungs are in relative emphysema in the recumbent position. This relative emphysema can be easily demonstrated by percussing over the liver and heart areas; the areas of dullness, invariably present in the erect posture in the normal individual, decrease or disappear when the subject lies on his back. Norris (5) finds that in the dorsal position the anterior margin of the lung moves downward, being about 2 cm. lower than in the erect posture. On fluoroscopic examination, there is an increased transparency of the lungs in the recumbent position. In the obese or very muscular individual, in whom fluoroscopic examination is unsatisfactory in the erect position, we have learned to employ screening in the recumbent position, as the results are found to be more satisfactory. Films made in this position also show the lungs as more transparent than when they are made in the erect posture. The following conditions, however, militate against the usefulness of roentgenograms made in the recumbent position: 1. The diaphragm rises high in the chest (6), compressing or relaxing the lungs. 2. The heart is enlarged in its transverse diameter (7), encroaching on the lung fields. 3. The sternum moves cephalad (8), and with it the clavicles, encroaching on the apical regions. It is largely for these reasons that roentgenograms of the chest are routinely prepared in the erect position in spite of the increased radiability of the exposed portions of the lungs in the recumbent position. The objections mentioned do not apply, however, to films made in lateral recumbency.
Sternum
Diaphragm (acoustics)
Sitting
Pectoral muscle
Apex (geometry)
Body position
Cite
Citations (1)
The thoracic wall consists of a bony framework that is held together by twelve thoracic vertebrae posteriorly which give rise to ribs that encircle the lateral and anterior thoracic cavity. The first nine ribs curve around the lateral thoracic wall and connect to the manubrium and sternum. Ribs 10-12 are relatively short and attach to the costal margins of the ribs just above them. Ribs 10-12, due to their short course, they do not reach the sternum.The first seven ribs are termed true ribs and attach to the manubrium and directly attach to the body of the sternum. Ribs eight to ten only attach to the inferior part of sternum via the costal cartilages. Ribs 11-12 are termed floating ribs because they do not attach directly to the sternum. Ribs eight to ten are known as false ribs because they lack direct attachment to the sternum. At the level of the spine, the ribs articulate with the costal facet of two opposing vertebrae. An articular capsule surrounds the head of each rib, and the attachment to the transverse process is made with the help of the radiate ligament. Once the ribs leave the vertebrae, they gently curve around the lateral thoracic wall and approach the anterior wall of the thoracic cavity.The vertical bone of the chest, the sternum, defines the anterior chest wall. The three separate bone segments of different size and shape that make up the sternum include 1) the thick manubrium, 2) long body of the sternum, and 3) the xiphoid process. It develops independently of the ribs. In sporadic cases, the sternum may not fully form, and the underlying heart may be exposed.The most superior portion of the sternum is the manubrium, and it is also the first to form during embryogenesis. The sternal body and xiphoid process soon follow the manubrium in development. Anatomically, the manubrium is located at the level of thoracic vertebral bodies T3 and T4. The manubrium is also the widest and thickest segment of the sternum. During a physical exam of the chest, one noticeable feature of the manubrium is the presence of the suprasternal notch. On either side of this notch, one will feel the thick attachment from the clavicles. For access to the superior mediastinum, suprasternal goiter or thymus, some thoracic surgeons will only make a midline incision in the manubrium.The sternal body is located at the level of vertebral bodies T5-T9. It covers a significant portion of the mid-chest and is very strong. To access the chest cavity, surgeons usually cut through the sternum with a mechanical saw.The xiphoid process is a thin and very small bone. Its size may vary from two to five cm, and its shape is also variable. The xiphoid may appear bifid, oval or be curved inwards/outwards. In younger individuals, the xiphoid is mostly cartilaginous but is nearly wholly ossified by age 40. By the age of 60 and over, the xiphoid is almost certainly completely calcified. To perform pericardiocentesis safely the needle has to be placed directly underneath the xiphoid because the heart is just a few fingerbreadths below.
Sternum
Thoracic wall
Thorax (insect anatomy)
Thoracic cavity
Cite
Citations (0)
Sternum
Cite
Citations (0)
In Emu the sternum was large and bowl shaped. The craniolateral processes were short, wide and flattened while presternum, caudolateral processes were absent. The lateral border of the sternum showed oval facets for the ribs from 4th to 5th. In Emu 9 pairs of ribs were present. The 1st, 2nd, 3rd, 8th and 9th pairs were floating type and showed only vertebral ribs, while 4th-5th pairs showed sternal ribs also in addition to vertebral ribs. Each rib consisted of a shaft and proximal and distal extremities. The proximal extremity of vertebral rib showed a head, long neck and tubercle. The ventral ends of vertebral ribs were narrow and pointed while the ventral ends of sternal ribs were wide and flattened and articulated with sternum. The proximal ends of sternal ribs form gliding joints with dorsal extremity of vertebral ribs 4–7.
Sternum
Cite
Citations (1)