Pectus Excavatum

(Funnel Chest)
  • Definition

    Pectus excavatum is an abnormal inward curve to the breastbone. It may be visible at birth. Growth through adolescence can make the indentation of the chest more apparent. It may continue until it has created a bowl-shape dent in the center of the chest.
    Severe forms can create extra pressure on the heart and lungs. This can lead to more serious health problems like shortness of breath and limited physical activities.
  • Causes

    The exact cause of pectus excavatum is not known. Some theories include:
    • Pressure in womb during pregnancy
    • Excessive pulling on breastbone and rib cage from shortened tendons of diaphragm muscles
    • Abnormalities in cartilage of the rib cage
    • Genetic factors
    The Rib Cage
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    Pectus excavatum may also be caused by conditions that affect connective tissue or chest structure, such as:
  • Risk Factors

    Risk factors include:
    • Family history of pectus excavatum
    • Gender: more common in boys
    Complications from pectus excavatum tend to increase with age due to bone growth and a decrease in the flexibility of the bones.
  • Symptoms

    Pectus excavatum is characterized by an indentation in the front of the chest wall. It may be mild or deep enough to form a bowl shape.
    If the indentation is severe enough to affect the heart or lungs you may also have:
    • Difficulty exercising
    • Unexplained shortness of breath
    • Mild chest pain
    • Frequent respiratory tract infections (eg, cold , bronchitis , pneumonia ) that last longer than normal
    A person with this condition may not have any symptoms during childhood. But as the person grows into an adolescent, he may have symptoms because of of a more pronounced indentation in the chest wall.
  • Diagnosis

    Your doctor will:
    • Ask about your symptoms
    • Take your medical history
    • Do a physical exam
    Your doctor will often be able to diagnose pectus excavatum after a physical exam.
    Additional tests may be done to find out if your heart or lungs are affected. These tests may include:
    • CT scan —a type of x-ray that uses a computer to make pictures of structures inside the chest. This is done to determine if the heart is squashed in the chest.
    • Pulmonary function test —a group of tests done to assess breathing ability. They will assess if your lungs have any difficulty moving adequate amounts of air.
    • Electrocardiogram (ECG, EKG)—a test that records the heart’s activity by measuring electrical currents through the heart muscle
    • Echocardiogram —a test that uses sound waves (ultrasound) to examine the size, shape, and motion of the heart.
  • Treatment

    Talk with your doctor about the best treatment plan for you. Options include:
    Surgery
    Surgery may be considered if you:
    • Have impairments of the heart or lungs
    • Have difficulty with physical activity
    • Are uncomfortable with the appearance of your chest
    The ideal age for this type of surgery is 7-14 years. But surgery can also be successful in adults, as well. There are two main surgical options:
    Open Surgery (Ravitch Procedure)
    This surgery involves incisions in the front of the chest. The surgeon will be able to see your breastbone. Some cartilage will be removed from your breastbone and nearby ribs. The surgeon will place the breastbone in its proper position. A metal strut and mesh will be used to support the new position. The metal strut may come out in 6-12 months.
    Minimally Invasive Surgery (Nuss Procedure)
    Small incisions are made on either side of the chest. The surgeon will place a metal bar through the incisions and secure it under the breastbone. This bar will push the breastbone into a better position. This bar will remain in the chest for 2-3 years. This will allow the chest time to remodel itself.
    Exercise
    Your doctor or physical therapist may recommend exercises or a rehabilitation program. Certain exercises and postural positions may decrease the appearance of mild pectus excavatum.
  • Prevention

    There is no known way to prevent this condition.
  • RESOURCES

    American Pediatric Surgical Association http://www.pediatricsurgerymd.org/

    American Surgical Association http://www.americansurgical.info/

    CANADIAN RESOURCES

    Canadian Association of General Surgeons http://www.cags-accg.ca/

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    References

    Goretsky MJ, Kelly RE Jr, Croitoru D, Nuss D. Chest wall anomalies: pectus excavatum and pectus carinatum. Adolesc Med Clin. 2004;15(3):455-471.

    Jaroszewski D, Notrica D, McMahon L, Steidley E, Descahmps C. Current management of pectus excavatum: a review and update of therapy and treatment recommendations. J Am Board Fam Med. 2010;23(2):230.

    Mavanur A, Hight DW. Pectus excavatum and carinatum: new concepts in the correction of congenital chest wall deformities in the pediatric age group. Conn Med. 2008;72(1):5-11.

    Pectus excavatum. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated March 19, 2012. Accessed May 16, 2012.

    Pectus excavatum. McMaster Children’s Hospital website. Available at: http://www.hamiltonhealthsciences.ca/documents/Patient%20Education/PectusExacavatum-lw.pdf . Accessed May 17, 2012.

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