Pectus carinatum

Chest wall deformity characterized by outward protrusion of the sternum

Pectus carinatum
Synonyms	Pigeon chest, pectus cavernatum, bird chest, convex chest
Pronounce
Field	Orthopedics, Pediatrics
Symptoms	Outward protrusion of the chest wall, shortness of breath, fatigue
Complications	Respiratory difficulty, self-esteem issues, scoliosis, mitral valve prolapse
Onset	Typically in adolescence
Duration	Lifelong if untreated
Types	Symmetrical and asymmetrical; includes pectus arcuatum
Causes	Overgrowth of costal cartilage, genetic syndromes, rickets, post-surgical
Risks	Family history, connective tissue disorders, vitamin D deficiency
Diagnosis	Clinical examination, CT scan, X-ray
Differential diagnosis	Pectus excavatum, thoracic scoliosis
Prevention	Not preventable (often congenital)
Treatment	Orthotic bracing, surgery
Medication	Not applicable
Prognosis	Generally good with treatment
Frequency	Relatively rare
Deaths	None directly attributed

Pectus carinatum, also called pigeon chest, is a congenital or developmental deformity of the chest wall characterized by an outward protrusion of the sternum and adjacent costal cartilage. It is less common than its counterpart, pectus excavatum, and typically becomes noticeable during the adolescent growth spurt.

Signs and symptoms

Individuals with pectus carinatum may present with the following features:

• Prominent, outward bowing of the chest wall
• Shortness of breath, particularly during exercise
• Fatigue and reduced stamina
• Use of accessory muscles of respiration due to inefficient breathing
• Mild to moderate asthma symptoms
• Scoliosis (curvature of the spine)
• Mitral valve prolapse
• Discomfort or tenderness over the chest

While the condition does not typically affect heart or lung development, the shape of the chest may impede optimal respiratory function in severe cases. Children may tire easily during physical activities. In many cases, pectus carinatum is also associated with psychological and emotional challenges related to body image and self-confidence.

Types

• Symmetrical pectus carinatum: Equal protrusion of the sternum across both sides of the chest.
• Asymmetrical pectus carinatum: One side of the sternum protrudes more than the other.
• Pectus arcuatum (Currarino–Silverman syndrome): A rarer variant with upward bowing of the upper sternum.

Causes

The exact cause of pectus carinatum is often unknown but may involve:

• Overgrowth of costal cartilage
• Genetic predisposition – a family history is noted in ~25% of cases
• Syndromic associations:
  • Marfan syndrome
  • Ehlers–Danlos syndrome
  • Noonan syndrome
  • Turner syndrome
  • Morquio syndrome
  • Loeys–Dietz syndrome
  • Homocystinuria
  • Multiple lentigines syndrome
  • Osteogenesis imperfecta
• Vitamin D deficiency leading to rickets
• Complications after open-heart surgery
• Chronic respiratory disorders such as poorly controlled bronchial asthma

Diagnosis

Diagnosis is typically made based on:

• Physical examination by a physician
• Chest X-ray or CT scan – to evaluate chest wall anatomy
• 3D imaging may be used to assess the severity and guide treatment
• Differentiation from similar conditions such as pectus excavatum

Severity is determined based on the degree of protrusion and the impact on respiratory function or psychological health.

Treatment

Orthotic bracing

Orthotic bracing is the first-line treatment in most adolescents with flexible chest walls. It involves wearing a custom-fitted chest brace that applies pressure to correct the protrusion over time.

• Non-surgical
• Worn for several hours per day (usually 14–16 hours)
• Best results when started before the chest wall hardens (usually before age 18)
• Requires long-term compliance and follow-up

Surgical intervention

Surgery may be considered in severe or rigid cases, or when bracing is unsuccessful.

• Ravitch procedure: Traditional surgical correction involving resection of abnormal cartilage and sternal realignment.
• Minimally invasive techniques: Still under investigation for pectus carinatum.

Supportive management

• Breathing exercises and physical therapy
• Psychological counseling for self-esteem issues
• Management of associated conditions like scoliosis or asthma

Prognosis

With appropriate treatment, especially early bracing, most individuals achieve excellent cosmetic and functional results. Surgery is effective but involves greater risk and recovery time.

Untreated severe cases may persist into adulthood, potentially affecting posture, respiratory efficiency, and self-image.

See also

• Pectus excavatum
• Costal cartilage
• Sternum
• Chest wall deformities
• Marfan syndrome
• Rickets

External links

• Pectus Carinatum – Children's Hospital of Philadelphia
• Pectus Carinatum – NCBI Bookshelf