Chest Wall Disorder: Pectus Excavatum

What Is Pectus Excavatum?

Pectus excavatum is when the ribs and the breastbone (sternum) grow inward and form a dent 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
• Poland syndrome
• rickets
• scoliosis

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

What Are the Signs & Symptoms of Pectus Excavatum?

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

• problems tolerating exercise
• tiredness
  
• chest pain
• a rapid heartbeat or heart palpitations
• 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. If needed, they might also order tests such as:

• 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?

Most kids with mild pectus excavatum who aren't bothered by their appearance and don't have breathing problems 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 14–21 years old.

The Nuss procedure is a 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.

What Else Should I Know?

Mild pectus excavatum doesn’t need treatment. But when the condition is very noticeable, it can affect a person's self-image. Severe pectus excavatum can make it hard for someone to play sports or exercise, and cause other health problems. In those cases, treatment can improve a child's emotional and physical well-being.

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