Pectus Excavatum

Overview

Definition

Pectus excavatum is an abnormal inward curve of the breastbone. It may be visible at birth.

Severe forms can put pressure on the heart and lungs. Early treatment can improve outcomes.

Causes

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

  • Excessive pulling on the breastbone and rib cage from shortened diaphragm muscle tendons
  • Abnormalities in cartilage of the rib cage
The Rib Cage
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Risk Factors

This problem 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

SymptomsandDiagnosis

Symptoms

The main problem is an indentation in 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 indentation 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 your symptoms and health history. 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.

Treatments

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 this health problem.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

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RESOURCES

Healthy Children—American Academy of Pediatrics http://www.healthychildren.org 

Ortho Info—American Academy of Orthopaedic Surgeons http://www.orthoinfo.org 

CANADIAN RESOURCES

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

Health Canada https://www.canada.ca 

References

Kelly RE Jr, Daniel A. Outcomes, quality of life, and long-term results after pectus repair from around the globe. Semin Pediatr Surg. 2018;27(3):170-174.

Mao YZ, Tang ST, et al. Comparison of the Nuss versus Ravitch procedure for pectus excavatum repair: an updated meta-analysis. J Ped Surg. 2017;52(10):1545-1552.

Obermeyer RJ, Goretsky MJ. Chest wall deformities in pediatric surgery. Surg Clin North Am. 2012 Jun;92(3):669-84, ix.

Pectus excavatum. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/pectus-excavatum. Accessed February 18, 2021.

Pectus excavatum. McMaster Children's Hospital website. Available at: https://www.hamiltonhealthsciences.ca/wp-content/uploads/2019/03/pectus-excavatum-overview-oct-2013.pdf. Accessed February 18, 2021.