Abstract Spontaneous pneumothorax (SP) most commonly presents as primary spontaneous pneumothorax in tall, thin males aged 15-40 years without underlying lung disease. Established risk factors include cigarette smoking, male sex, tall body habitus, and certain genetic syndromes. While pectus excavatum has been associated with SP, pectus carinatum—a deformity characterized by outward protrusion of the sternum and ribs—has rarely been implicated. Evidence linking pectus carinatum to pneumothorax is sparse, with most literature focusing on cosmetic or mild respiratory effects. We present a case of recurrent SP in a young man with pectus carinatum, suggesting a potential structural contribution. A 19-year-old male with pectus carinatum presented with one day of dyspnea and pleuritic chest pain. He had a history of left SP two years prior treated with VATS apical bleb resection and pleurectomy, but had suffered a left recurrent spontaneous pneumothorax (RSP) one year prior that had resolved with conservative management. Vital signs were normal with arterial oxygen saturation 100% on room air. Chest radiograph revealed a moderate left pneumothorax. CT imaging revealed moderate left pneumothorax with minimal right apical paraseptal emphysema and left apical scarring. There was pectus carinatum with the sternum tilted toward the left. Family history was negative for pneumothorax or chest wall deformities. He denied smoking and vaping. Workup revealed normal alpha 1 antitrypsin level with phenotype MM and normal homocysteine level. He was given high flow supplemental oxygen via non-rebreather mask, and with serial radiographic observation the pneumothorax improved and symptoms resolved over three days. He was discharged home with plans for follow up in Thoracic Surgery clinic. RSP typically results from apical bleb rupture in young males. However, recurrence despite surgical pleurectomy suggests additional contributing factors. Pectus carinatum may alter thoracic mechanics by anterior displacement of the sternum and costal cartilages which could produce regional pressure gradients and increased shear forces that promote bleb formation and rupture. In our patient, RSP without smoking or identified genetic diseases raises the concern that chest wall abnormalities could have contributed to localized pleural stress. Recognition of chest wall morphology in recurrent SP may improve risk stratification and management planning. Additionally, evaluation of thoracic geometry could help identify patients at risk for recurrence. Pectus carinatum may represent an underrecognized structural risk factor for recurrent spontaneous pneumothorax through mechanical mechanisms despite prior surgical intervention. We present this case to aid in recognition of a potential association of pectus carinatum with recurrent pneumothoraces. This abstract is funded by: None
Piroozi et al. (Fri,) studied this question.