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A male 58 year old patient with mixed lung disease, celiac sprue, and left lower lobe tumor was referred for pre-operative lung cancer evaluation due to concern by the surgical team over the patient's underweight status. A 10 Watt/min incremental cardiopulmonary exercise test was performed to assess functional capacity. Peak VO2 and split lung function scan were utilized to assess predicted post-operative status. The underweight status of the patient required adjustment of predicted values to accurately reflect the patient's true functional capacity. Peak VO2 of > 1000 mL/min, 23.1 mL/kg/min, and 60% predicted provide a reasonable prognosis. [ABSTRACT FROM AUTHOR]

Pectus excavatum (PE) is a relatively common congenital deformity of the anterior chest wall associated with reduced exercise capacity. Uncertainty exists over the nature of physiologic impairment in PE. Evidence suggests that myocardial compression exerted by the displaced sternum on the right heart chambers, disables the ability of the heart to augment stroke volume during exercise. This case study describes the evaluation of an athletic 20 year old Caucasian male, lifelong non-smoker, with severe pectus deformity and previous fixation procedure to repair a sternal fracture. The patient performed an incremental cycle ergometer exercise test to determine the etiology of his dyspnea with exertion. The patient demonstrated normal work output and normal aerobic capacity but displayed dynamic hyperinflation. Mechanical restriction of tidal volume expansion appeared to be the major contributors to exercise limitation. These results are compared and contrasted with similar cases reported in the literature. Key PointsPectus excavatum (PE) is a relatively common phenomenon affecting approximately 1 in 300 births, with a 9:1 ratio of male to female rate of incidence.The etiology or exercise limitation is most frequently due to cardiovascular limitation due to the compression of the sternum upon the myocardium, impairing the ability to augment stroke volume.The Pectus Severity Index (PSI) is a useful indicator of pectus severity.Cardiopulmonary exercise testing provides useful data to distinguish between cardiovascular limitation, ventilatory limitation, or deconditioning in the evaluation of PE.In this case study, ventilatory limitation was due to the mechanical restriction of the thoracic cavity.