Adolescent Girl\Pectus Excavatum\Scoliosis\Triage Approach

Pectus excavatum chest wall correction surgery was performed in the thoracic surgery department.

This case falls within the scope of multidisciplinary joint diagnosis and treatment overall. However, the clinical management did not incorporate the case into a multidisciplinary framework, which represents a fundamental error. A fundamental error is a major error and an unforgivable one. The multidisciplinary framework for this case should involve pediatrics, genetic medicine, rheumatology and immunology, cardiology, vascular surgery, orthopedics, thoracic surgery, radiology, and others. It should be led by pediatrics or rheumatology and immunology. The condition in this case is a systemic disease, essentially medical in nature, with surgery addressing only localized manifestations. First, the discharge record did not document the patient’s age, which is non-standard. Age is a very important consideration in this case. Second, the patient is 13 years old with no prior history of scoliosis or pectus excavatum. These issues appeared only in the past 5 months, indicating that the case should be considered within the category of heritable connective tissue disorders, including but not limited to Marfan syndrome and Loeys-Dietz syndrome. Third, the echocardiography report in the discharge summary did not include measurements of great vessel diameters or other structural details, which is concerning. Fourth, the discharge summary did not specify the surgery date, making it impossible to determine whether the echocardiography was pre- or post-operative. This affects the assessment of surgical appropriateness for pectus excavatum. Fifth, the CT indicated morphological abnormality (widening/flattening) of the anterior margin of the left second rib, also suggesting a tendency toward connective tissue disease. Sixth, the discharge summary described the patient’s visit as being “for surgery,” which is appropriate in wording. The patient came for consultation, and the diagnostic and treatment pathway should undoubtedly be physician-led. Physicians should not imply that surgery was performed solely because of unilateral patient demand. Seventh, if this case is confirmed as a connective tissue disorder, the family should be informed that survival for such conditions may differ significantly from the general population. This helps families understand that surgery is only a temporary measure to relieve specific symptoms. Eighth, even when deciding on surgical correction, coordination between scoliosis and pectus excavatum corrections is necessary. Therefore, a multidisciplinary evaluation involving thoracic surgery and orthopedics should have been conducted. This consideration was not reflected in the discharge summary.

Before the surgery, the patient’s family indirectly contacted this website, but the patient ultimately proceeded with the operation. The key point is that they reached out through others rather than contacting the website directly themselves. Indirect contact distorts the original information and reduces the effectiveness of communication.