Which of the following statements about pectus excavatum are correct?

A. It is the most common congenital malformation of the chest wall.

B. The most frequent presenting complaint is the cosmetic deformity

D. It may be associated with cardiac defects and other skeletal defects such as scoliosis.

E. Restrictive alterations in chest wall mechanics and abnormalities in pulmonary function tests have been documented.

DISCUSSION: Congenital deformities of the chest wall represent a spectrum of deformities ranging from minor cosmetic defects to gross deformities incompatible with life. Pectus excavatum, or funnel chest, is the most common of the congenital deformities of the chest wall, accounting for 90% of such defects. It is characterized by a concave, posteriorly displaced sternum due to overgrowth of the costal cartilages. Most commonly the defect begins at the junction of the manubrium and the body of the sternum and becomes progressively deeper toward the xiphoid. The manubrium and the first and second costal cartilages typically are normal. The defects have both physiologic and psychologic consequences and are often associated with other abnormalities, including congenital heart disease, Marfan's syndrome, and other skeletal defects, including scoliosis. Patients most often present because of the cosmetic defect but frequently are found to have other symptoms, including impaired cardiopulmonary function and scoliosis. Pulmonary complaints include dyspnea and respiratory tract infections. Restrictive alterations in chest wall mechanics and abnormalities in pulmonary function tests, including decreased vital capacity, decreased total lung capacity, decreased maximal ventilatory volume, and decreased maximal breathing capacity, have been documented.