Pectus excavatum is a
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:
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
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.
