Transverse MR image at level of lower chest demonstrating severe pectus excavatum deformity with displacement off the heart into the left haemithorax with severe compression of the right atrium, the xiphisternum appears to cause compression of the liver and inferior vena cava. The patient experiences dyspnoea during exercise and un-provoked syncope, achieving a VO2 max of 77% of predicted and breathing reserve of 74% at peak exercise.