Pectus excavatum

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Pectus excavatum
Synonyms	Funnel chest, sunken chest
Pronounce	N/A
Specialty	Thoracic surgery, Pediatrics
Symptoms	Chest pain, shortness of breath, fatigue
Complications	Cardiac compression, respiratory issues
Onset	Childhood
Duration	Lifelong
Types	N/A
Causes	Genetic factors, connective tissue disorders
Risks	Marfan syndrome, Ehlers-Danlos syndrome
Diagnosis	Physical examination, imaging studies
Differential diagnosis	Pectus carinatum, scoliosis
Prevention	None
Treatment	Surgical repair, physical therapy
Medication	Pain management
Prognosis	Generally good with treatment
Frequency	1 in 300-400 births
Deaths	N/A

Pectus excavatum

X-ray of pectus excavatum

Vacuum bell for pectus excavatum

Pectus excavatum

Pectus excavatum, also known as "funnel chest" or "sunken chest", is a congenital chest wall deformity characterized by a concave, or caved-in, appearance of the sternum. The severity of the condition varies between individuals, and it can range from a mild indentation to a severe depression, potentially impacting surrounding organs.

Pathophysiology

Pectus excavatum results from an excessive growth and abnormal orientation of the costal cartilages, leading to the depression of the sternum. This growth disturbance is usually noted in the first year of life and becomes more pronounced during the rapid growth period of puberty. Although the exact cause is not known, it is believed to have a genetic component, as it frequently occurs in families and is often associated with other genetic disorders such as Marfan syndrome and Ehlers-Danlos syndrome.

Clinical Presentation

Clinically, the hallmark of pectus excavatum is a visibly sunken sternum, which can become more pronounced with growth or physical activity. The condition may cause discomfort or pain in the chest and back, and it may also affect respiratory function in severe cases, leading to shortness of breath, especially during physical activity. It is also common for individuals with pectus excavatum to experience feelings of self-consciousness due to the appearance of their chest.

Diagnosis

Diagnosis of pectus excavatum is typically made based on physical examination. Imaging studies, such as chest X-rays, CT scans, or MRI, may be used to assess the severity of the depression and its effect on the heart and lungs. Pulmonary function tests may also be performed to evaluate any breathing difficulties.

Management and Treatment

The management of pectus excavatum depends on the severity of the symptoms and the impact on the patient's quality of life. Mild cases without significant symptoms or functional impairment may not require any specific treatment except for regular monitoring. For moderate to severe cases, surgical correction may be recommended. The most common procedure is the Nuss procedure, a minimally invasive approach that involves the insertion of a curved metal bar to correct the shape of the sternum. Postoperative pain management is an essential part of the recovery process. Physical therapy exercises may also help to improve posture, increase lung capacity, and strengthen chest wall muscles.

Pectus_excavatum images

• 
  Modified Ravitch procedure
• 
  Scar from Ravitch procedure
• 
  X-ray after Nuss procedure

References

• Pectus Excavatum: History, Questions and Controversies
• The management of pectus excavatum: a comparative study of the Nuss and Ravitch procedures
• Physical therapy for a child with pectus excavatum and bilateral hip dysplasia: a case report

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