Pectus Excavatum/Carinatum
OVERVIEW
Pectus deformities occur in 1-8: 1000 population and are more
frequent in boys than girls. In pectus excavatum (funnel chest)
the sternum (breastbone) is depressed in a concave shape and
in pectus carinatum (pigeon chest) the sternum is protruded in a
convex shape. There may be asymmetry of the chest and the
sternum may be rotated. The deformity varies in severity,
ranging from a mild indentation/protrusion to severe, for
example a patient with a severe pectus excavatum may have
only a few centimeters between his/her sternum and vertebral
column. Most patients have a slim chest, a slouching posture and
younger children commonly have potbellies.
BACKGROUND
The deformity is thought to be caused by excessive growth of the costal cartilages although the
reason for this is unknown. This overgrowth causes the ribs and cartilages to 'buckle' and pushes
the sternum either inwards or outwards. Musculoskeletal abnormalities that are associated with
pectus deformities are scoliosis, Marfan's syndrome, and Poland's syndrome. The deformity is
often noticeable at birth but becomes more apparent during the period of rapid skeletal growth
in early adolescence. After the age of approximately 18 years of age the deformity remains the
same. Gaining weight and chest hair (in men) usually reduces the appearance of the deformity.
CLINICAL PRESENTATION AND DIAGNOSIS
In most patients there are no symptoms related to the shape of the chest. Patients usually
present with concern about the appearance of the chest. The physiological effects of pectus
deformities remain debatable. However, psychological difficulties facing patients are evident but
there is little objective data to know the long-term
effects or issues. Some studies have documented a
decrease in stamina and endurance during strenuous
exercise, more frequent respiratory infections, chest pain,
and asthma. However, pulmonary and functional testing
does not consistently demonstrate physiological limitations.
TREATMENT
Pectus cavus or pectus excavatum deformity ranges from
mild to severe. Typically the malformation produces few
symptoms and is sometimes considered a cosmetic issue.
Some patients are able to accept and live happily with the
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shape of their chest. However many patients with pectus deformities are affected with a
negative self-image and low self-confidence. A common complaint is an unwillingness to be seen
without a shirt while swimming and participating in sports or social activities. There is not good
data to suggest that the deformity will improve with age. Treatment recommendations are based
on severity of the deformity and the patient's and parents attitude to the resulting cosmetic
issues with and without treatment. In general, less than 15% of patients with a pectus deformity
undergo treatment.
Conservative methods of treatment may be helpful in some situations. However, the results from
the reported studies are questionable due to the small sample size and limited long-term results.
Counseling and education may improve the patient's or the parent's attitudes toward the
deformity. Parental attitudes seem to be a primary factor for a child's adjustment. Some parents
dismiss the pectus deformity as being part of the person, like the color of the child's hair or
eyes and the child may mature believing he/she is no more different than the next child. However
other parents seem to draw attention to the deformity and heighten anxiety. Parents of young
children should encourage acceptance and coping strategies so that their child can adapt with
their deformity. Psychological support and counseling may be of benefit.
Physiotherapy and posture improvement programs may help patients with pectus deformities.
Many patients have rounded shoulders and a slouching posture and would benefit from these
techniques, with or without additional surgical correction. However body-building type exercises
usually result in worsening of cosmetic appearance due to the enhancement of the pectoral
muscles.
Surgical treatment is possible, but has risks and benefits. Pectus correction surgery is usually
performed by some, but not all thoracic surgeons, pediatric general surgeons, or plastic surgeons
who specialize in this area. Surgical correction of pectus deformities can now be performed with
low morbidity, low cost, and minimal limitation in activity. One recent study reported that 97% of
patients had a very good or excellent result.
MORE INFORMATION
Further information can be obtained on the internet. Your local public library can help you explore
these sources if you are interested. Two good sites for expert and peer reviewed information are
the American Academy of Orthopedic Surgeons at www.aaos.org and www.emedicine.com.
FEEDBACK
If you have questions or comments, please contact the office or submit them to the web site at
www.pedortho.com.
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