1. Tracheal Compression Caused by Straight Back Syndrome, Chest Wall Deformity, and Anterior Spinal Displacement: Techniques for Relief 
Hermes C. Grillo, MD, Cameron D. Wright, MD, Philippe G. Dartevelle, MD, John C. Wain, MD, Shinya Murakami, MD 
The Annals of Thoracic Surgery 
Volume 80, Issue 6, Pages (December 2005)
DOI: /j.athoracsur
Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
Straight back syndrome, patient 1. (A) Lateral view shows the narrowness of the patient’s chest, and a spine lacking normal curvatures. Mild pectus excavatum is present but not seen. (B) Posterior view. Normal dorsal kyphosis of the vertebral column is absent.
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3. Fig 2
Chest roentgenogram, patient 1. (A) The flattened trachea appears broad and widens distally even more. (B) Lateral roentgenogram emphasizes the straight vertebral column. Note the narrowness of the thorax.
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Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
Straight back syndrome, patient 1. (A) Computed tomographic scan at the thoracic inlet. The trachea is flattened to a slit between the manubrium sterni (and also by the brachiocephalic artery) and the vertebral column. Haller’s “pectus index” (ratio of transverse internal diameter of the thorax to anteroposterior distance between sternum and vertebra, measured on computed tomographic scan) is 10.8:1 in this patient. Normal is less than In Haller’s 13- to 18-year-old group of patients selected for pectus repair, the maximum indices were about 5:1 (Haller JA Jr, Kramer SS, Lietman SA. Use of CT scans in selection of patients for pectus excavatum surgery: a preliminary report. J Pediatr Surg 1987;22:904–6). (B) The distal trachea is splayed against the vertebral column, with a widened membranous wall.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

5. Fig 4
Surgical correction of tracheal obstruction caused by severe straight back syndrome, with mild pectus excavatum. (a) Diagram of incision, patient 1. In patient 2 the curved incision alone was made to suffice by moving it further caudad for cosmetic reasons. (b) Sagittal diagram illustrating points of tracheal compression. The tracheal lumen is diagrammed at the right of each point of obstruction. The proximal sternum squeezes the trachea against the vertical vertebral column. Note the minimal distance between the sternum and the vertebrae. The brachiocephalic artery compresses the trachea similarly. The lower intrathoracic trachea is splayed against the vertebral column. This was not present in patient 2 or 3. (c) Postoperative correction. The obstructing proximal sternum and compressive brachiocephalic artery have been removed. The artery was transplanted laterally and the lower trachea and bronchi were splinted posteriorly with Marlex [2]. (d) The brachiocephalic artery was lengthened with a graft and rerouted lower and lateral to the trachea in patients 1 and 2. (Reprinted from Grillo HC, Surgery of the trachea and bronchi; 2004:424–7 [2], with permission.)
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6. Fig 5
Postoperative computed tomography scans in patient 1 showing a very adequate lumen in both the upper [A] and lower [B] trachea. Note the sternal alteration in A, compared with Figure 3A, and the thickened membranous wall of the trachea in B, compared with Figure 3B.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

7. Fig 6 Bronchoscopic view of compressed trachea in patient 2.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
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8. Fig 7
Preoperative thoracic computed tomographic scan in patient 4 showing marked anteroposterior narrowing of the upper mediastinum that compressed the trachea. An endotracheal tube is necessarily in place.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

9. Fig 8
Postoperative thoracic computed tomographic scan, patient 4, showing the distracted sternum and a very adequate tracheal lumen. Contrast is present in the superior vena cava.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions