Chest Wall Disorder: Pectus Carinatum

What Is Pectus Carinatum?

Pectus carinatum is a genetic disorder of the chest wall. It makes the chest jut out. This happens because of an unusual growth of rib and breastbone (sternum) cartilage .

The bulging gives the chest a birdlike appearance. That's why the condition is sometimes called pigeon breast or pigeon chest.

What Causes Pectus Carinatum?

Doctors don't know exactly what causes pectus carinatum (PEK-tus kair-ih-NOT-um). In some cases, it runs in families.

Kids who have it often have another health condition, such as:

• Down syndrome: a genetic disorder caused by the presence of all or part of an extra copy of chromosome 21
• Edwards syndrome : a genetic disorder caused by the presence of all or part of an extra 18th chromosome
• Marfan syndrome: a disorder that affects the body's connective tissue
• homocystinuria: a disorder that involves a problem with an amino acid that the body uses to make protein and build tissues
• Morquio syndrome: unusual growth, development, shape, or integrity of the bones and cartilage. It often causes dwarfism.
• osteogenesis imperfecta (brittle bone disease): this condition makes bones very fragile

What Are the Signs & Symptoms of Pectus Carinatum?

A pushed-out chest is the chief sign of pectus carinatum. This usually doesn't appear until a child is age 11 or older, even though the condition is present at birth.

The chest wall surrounds and protects the heart and lungs. So kids and teens with pectus carinatum may:

• feel short of breath, especially during exercise
• have a fast heartbeat
• feel tired
• have chest pain

Some can develop asthma or get a lot of respiratory infections.

Pectus carinatum can affect one side of the chest more than the other. Sometimes, kids have pectus carinatum on one side of the chest, and a different chest wall disorder — pectus excavatum — on the other side. Pectus excavatum makes the chest look sunken.

The condition gets worse as kids grow, and affects boys more often than girls.

How Is Pectus Carinatum Diagnosed?

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

• chest X-ray to check the severity of the condition
• imaging scans like computed tomography (CT) or magnetic resonance imaging (MRI)
• electrocardiogram to see how the heart is working
• pulmonary function tests to check the lungs
• genetic testing to look for related syndromes

How Is Pectus Carinatum Treated?

Kids and teens with mild pectus carinatum might not have breathing problems or worry about their appearance. If so, they don't need treatment.

Kids whose bones are still growing can wear a chest brace. Much like how braces realign teeth, a chest brace will push the breastbone back to a normal position. Kids need to wear a brace for 6 months to a year. They can remove it for sports, showering, and other activities, but usually must wear it for 8 hours a day or longer.

In some cases, surgery can treat pectus carinatum. In the Ravitch procedure, a surgeon:

• removes damaged cartilage
• repairs or reshapes the sternum
• places a bar (or bars) in the chest wall to hold it in the proper position

The surgeon removes the bar in a later surgery, usually after about 6 months. The Ravitch procedure is most often used for patients 13 to 22 years old.

Doctors also might recommend physical therapy and exercises to strengthen weak chest muscles.

Looking Ahead

Mild pectus carinatum won't need treatment if 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. In those cases, treatment can improve a child's physical and emotional well-being.

Most kids and teens who wear a brace or undergo surgery do very well and are happy with the results.