Unexpected pectus carinatum: Reverse bending of xiphisternal joint after modified Nuss procedure

The pectus carinatum has been rarely reported as complication after Nuss procedure. The case we present here is that of a 14-year-old Chinese male who underwent modified Nuss procedure to correct pectus excavatum and presented a sudden pectus carinatum two months after surgery. By comparing the pre- and post-operative chest computed tomography (CT) of the patient, we believe the secondary pectus carinatum might be caused by the reverse bending of xiphisternal joint. The case made us aware of some shortcomings of the new modified bar and highlights the importance of a comprehensive evaluation of sternum development.