Chest Wall Disorder: Pectus Excavatum

What Is Pectus Excavatum?

Pectus excavatum is a congenital deformity of the chest wall that causes several ribs and the breastbone (sternum) to grow in an inward direction.

Usually, the ribs and sternum go outward at the front of the chest. With pectus excavatum, the sternum goes inward to form a depression in the chest. This gives the chest a concave (caved-in) appearance, which is why the condition is also called funnel chest or sunken chest. Sometimes, the lower ribs might flare out.

What Causes Pectus Excavatum?

Doctors don't know exactly what causes pectus excavatum (PEK-tus eks-kuh-VAY-tum). In some cases, it runs in families.

Kids who have it also may have another health condition, such as:

• Marfan syndrome: a disorder that affects the body's connective tissue
• Poland syndrome: a rare birth defect marked by missing or underdeveloped muscles on one side of the body, especially noticeable in the major chest muscle
• rickets: a disorder caused by a lack of vitamin D, calcium, or phosphate that leads to softening and weakening of the bones
• scoliosis: a disorder in which the spine curves incorrectly

It's not clear how these disorders are related to pectus excavatum.

What Are the Signs & Symptoms of Pectus Excavatum?

The main sign of pectus excavatum is a chest that looks sunken in. Even though kids who have pectus excavatum are born with it, it might not be noticed in the first few years of life. Many cases are found in the early teenage years.

Mild cases might be barely noticeable. But severe pectus excavatum can cause a deep hollow in the chest that can put pressure on the lungs and heart, causing:

• problems tolerating exercise
• limitations with some kinds of physical activities
• tiredness
• chest pain
• a rapid heartbeat or heart palpitations
• frequent respiratory infections
• coughing or wheezing

The condition typically gets worse as kids grow, and affects boys more often than girls. When a child is done growing, the pectus should not get any better or worse.

How Is Pectus Excavatum Diagnosed?

Health care providers diagnose pectus excavatum based on a physical exam and a child's medical history. If needed, they might also order tests such as:

• computed tomography (CT) scan and/or a chest MRI to see the severity and degree of compression on the heart and lungs
• echocardiogram to test heart function
• pulmonary function tests to check lung volume
• exercise stress testing to measure exercise tolerance

How Is Pectus Excavatum Treated?

Kids with mild pectus excavatum — who aren't bothered by their appearance and don't have breathing problems — typically don't need treatment.

In some cases, surgery can treat pectus excavatum. Two types of surgery are used:

• the open (or modified Ravitch) procedure
• the minimally invasive repair (or Nuss procedure)

In the Ravitch procedure, a surgeon removes abnormal cartilage and ribs, fractures the sternum, and places a support system in the chest to hold it in the proper position. As the sternum and ribs heal, the chest and ribs stay in the flat, more normal position. This surgery is typically used for patients 14 to 21 years old.

The Nuss procedure is a more recent, less invasive technique. Using small incisions, the surgeon inserts a curved metal bar to push out the sternum and ribs, helping reshape them. A stabilizer bar is added to keep it in place. The chest is permanently reshaped in 3 years and both bars are surgically removed. The Nuss procedure can be used with patients age 8 and older.

Doctors also might recommend physical therapy and exercises to strengthen the chest muscles improve posture.

Mild pectus excavatum in young patients often can be treated at home with a vacuum bell device. In this nonsurgical approach, the bell device is placed on the chest. It's connected to a pump that sucks the air out of the device, creating a vacuum that pulls the chest forward. Over time, the chest wall stays forward on its own.

Looking Ahead

Mild pectus excavatum won't need treatment if it doesn't affect how the lungs or heart work. But when the condition is very noticeable or causes health problems, a person's self-image can suffer. It also can make exercising or playing sports difficult. In those cases, treatment can improve a child's physical and emotional well-being.

Most kids and teens who have surgery do very well and are happy with the results.