Pectus Excavatum

Causes

It is not known why some children are born with pectus excavatum. It may be due to:

• Pulling on the breastbone and rib cage from shortened diaphragm muscle tendons
• Problems with the cartilage of the rib cage

The Rib Cage

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Risk Factors

Pectus excavatum is more common in men. It is also more common in people who are White. Other things that may raise the risk are:

• Having other family members with similar problems
• Scoliosis
• Marfan syndrome
• Ehlers-Danlos syndrome
• Osteogenesis imperfecta
• Turner syndrome

Symptoms

The main problem is an inward curve of the front of the chest wall. It may be mild or deep enough to form a bowl shape.

A child may not have symptoms until growth begins during the teenage years. A severe curve may cause:

• Difficulty exercising
• Shortness of breath with activity
• Rapid heartbeat
• Chest pain

Diagnosis

The diagnosis is often made in the first year of life.

The doctor will ask about symptoms and past health. A physical exam will be done. It will focus on the chest. This is often enough to make the diagnosis.

More tests will be done to find out if the heart and lungs are affected.

Treatment

People who do not have symptoms may not need treatment. Breathing exercises and aerobic activity may be advised.

In others, the goal of treatment is to repair the problem. It can ease symptoms and improve the way the chest looks. This is done with surgery. Choices are:

• Nuss procedure—secures a metal bar to the breastbone to push it into a better position for two to three years
• Ravitch procedure—removes cartilage from the breastbone and ribs, places the breastbone in its proper position, and uses a metal strut and mesh to hold it in place for 6 to 12 months

Prevention

There is no known way to prevent pectus excavatum.