The Haller index, created in 1987 by J. Alex Haller, S. S. Kramer, and S. A. Lietman,[1] is a mathematical relationship that exists in a human chest section observed with a CT scan. It is defined as the ratio of the transverse diameter (the horizontal distance of the inside of the ribcage) and the anteroposterior diameter (the shortest distance between the vertebrae and sternum).[2]
where:
HI is the Haller Index
distance 1 is the distance of the inside ribcage (at the level of maximum deformity or at the lower third of the sternum)
distance 2 is the distance between the sternal notch and vertebrae.
More recent studies show that simple chest x-rays are just as effective as CT scans for calculating the Haller index and recommend replacing CT scans with CXR to reduce radiation exposure in all but gross deformities.[3][4][5]
A normal Haller index should be about 2.5. Chest wall deformities such as pectus excavatum can cause the sternum to invert, thus increasing the index.[6][7] In severe asymmetric cases, where the sternum dips below the level of the vertebra, the index can be a negative value.[8]
↑ Haller JA, Kramer SS, Lietman SA (October 1987). "Use of CT scans in selection of patients for pectus excavatum surgery: a preliminary report". Journal of Pediatric Surgery. 22 (10): 904–6. doi:10.1016/s0022-3468(87)80585-7. PMID3681619.
↑ Khanna G, Jaju A, Don S, Keys T, Hildebolt CF (November 2010). "Comparison of Haller index values calculated with chest radiographs versus CT for pectus excavatum evaluation". Pediatric Radiology. 40 (11): 1763–7. doi:10.1007/s00247-010-1681-z. PMID20473605. S2CID23984787.
↑ Poston PM, McHugh MA, Rossi NO, Patel SS, Rajput M, Turek JW (November 2015). "The case for using the correction index obtained from chest radiography for evaluation of pectus excavatum". Journal of Pediatric Surgery. 50 (11): 1940–4. doi:10.1016/j.jpedsurg.2015.06.017. PMID26235532.
↑ Mueller C, Saint-Vil D, Bouchard S (January 2008). "Chest x-ray as a primary modality for preoperative imaging of pectus excavatum". Journal of Pediatric Surgery. 43 (1): 71–3. doi:10.1016/j.jpedsurg.2007.09.023. PMID18206458.
The rib cage, as an enclosure that comprises the ribs, vertebral column and sternum in the thorax of most vertebrates, protects vital organs such as the heart, lungs and great vessels.
Pectus excavatum is a structural deformity of the anterior thoracic wall in which the sternum and rib cage are shaped abnormally. This produces a caved-in or sunken appearance of the chest. It can either be present at birth or develop after puberty.
Pediatric surgery is a subspecialty of surgery involving the surgery of fetuses, infants, children, adolescents, and young adults.
Pectus carinatum, also called pigeon chest, is a malformation of the chest characterized by a protrusion of the sternum and ribs. It is distinct from the related malformation pectus excavatum.
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The Nuss procedure is a minimally-invasive procedure, invented in 1987 by Dr. Donald Nuss for treating pectus excavatum. He developed it at Children's Hospital of The King's Daughters, in Norfolk, Virginia. The operation typically takes approximately two hours.
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Flat-chested kitten syndrome (FCKS) is a disorder in cats wherein kittens develop a compression of the thorax (chest/ribcage) caused by lung collapse. This is a soft-tissue problem and is not caused by vertebral or bony malformation. However, lung collapse can be a secondary symptom caused by bony deformity affecting the thorax such as pectus excavatum. In mild cases, the underside of the chest becomes flattened ; in extreme cases the entire thorax is flattened, looking as if the kitten has been stepped on. The kitten will appear to go from normal to flat in the space of about 2–3 hours, and will usually then stabilise. FCKS is frequently misdiagnosed as pectus excavatum due to inadequate veterinary literature or lack of experience with the condition on the part of the clinician.
The sternum or breastbone is a long flat bone located in the central part of the chest. It connects to the ribs via cartilage and forms the front of the rib cage, thus helping to protect the heart, lungs, and major blood vessels from injury. Shaped roughly like a necktie, it is one of the largest and longest flat bones of the body. Its three regions are the manubrium, the body, and the xiphoid process. The word "sternum" originates from the Ancient Greek στέρνον (stérnon), meaning "chest".
Marcelo Martinez-Ferro was born in Buenos Aires and graduated from the Buenos Aires University School of Medicine in 1983. He completed his residency in pediatric surgery at the Ricardo Gutierrez Children´s Hospital and in 1988, joined the staff of Garrahan national Children`s Hospital. In 1992 he completed a fellowship at the Fetal Treatment Center of the UCSF where he confirmed his interest in fetal treatment and video surgery.
Chest pain in children is the pain felt in the chest by infants, children and adolescents. In most cases the pain is not associated with the heart. It is primarily identified by the observance or report of pain by the infant, child or adolescent by reports of distress by parents or caregivers. Chest pain is not uncommon in children. Many children are seen in ambulatory clinics, emergency departments and hospitals and cardiology clinics. Most often there is a benign cause for the pain for most children. Some have conditions that are serious and possibly life-threatening. Chest pain in pediatric patients requires careful physical examination and a detailed history that would indicate the possibility of a serious cause. Studies of pediatric chest pain are sparse. It has been difficult to create evidence-based guidelines for evaluation.
Sydney A. Haje was a Brazilian orthopedist, known internationally for his pioneering work on chest wall deformities including the creation of a conservative treatment protocol for the pectus carinatum and pectus excavatum conditions.
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