The pectus, or chest wall, is made up of bone and muscle covered by skin. It protects vital organs such as the heart, lungs and great vessels from injury, as well as aids the breathing process. Malformations can occur in the ribs and sternum of the chest wall, in which the sternum is abnormally sunken (pectus excavatum) or abnormally prominent (pectus carinatum). Pectus excavatum tends to be an inherited condition affecting males. Pectus carinatum may occur as a singular abnormality or in association with other genetic syndromes. Pectus malformations can have significant medical and psychological impact.
The Lung Center at Brigham and Women’s Hospital (BWH) offers proven treatments for patients with pectus excavatum and pectus carinatum. Our board-certified surgeons use safe and effective minimally invasive surgical techniques to correct pectus malformations, including the highly modified Ravitch technique and Nuss procedure, a minimally invasive approach using video-assisted thoracic surgery (VATS).
- Types of Pectus Malformation
- Causes of Pectus Malformation
- Symptoms of Pectus Malformation
- Diagnosis of Pectus Malformation
- Treatment for Pectus Malformation
- What You Should Expect
- Multidisciplinary Care
- Appointments and Locations
Pectus excavatum is a Latin term for “hollowed chest,” a malformation of the rib cage characterized by a sternum that caves in, causing a sunken appearance in the chest wall. Also known as “funnel chest” or “cobbler’s chest,” pectus excavatum is usually congenital and cases may range from mild to severe. It is not preventable, but has very high rates of successful treatment.
Pectus excavatum is often diagnosed and treated at birth or during childhood. Occasionally, it goes untreated and needs to be repaired during adulthood. If left untreated, severe cases of pectus excavatum can lead to compression of the heart and lungs.
Pectus carinatum, also called “pigeon chest,” is a rare congenital deformity of the chest wall characterized by the breastbone being pushed outward, giving a birdlike appearance. It is not considered life-threatening and often does not need treatment.
It is not known for certain what causes pectus excavatum. Some of the suspected causes or risks are:
- Excessive growth of connective tissue from the ribs to the sternum
- Genetic link: forty percent of patients with this condition have one or more family members with the same malformation
- Occurs more often in males
Most cases of pectus excavatum are not linked to other conditions. However, some disorders may include a sunken chest wall, such as:
- Marfan Syndrome, a connective tissue disorder
- Rickets, a bone disease caused by vitamin deficiency
- Scoliosis, curvature of the spine
There are generally no symptoms of pectus excavatum beyond the outward appearance of the chest wall. However, a small percentage of patients may experience:
- Shortness of breath
- Chest pain
- Decreased tolerance for exercise
- Fast heart rate (tachycardia)
In addition to a careful physical examination, your thoracic surgeon may perform the following procedures to confirm the diagnosis of pectus excavatum:
- Pulmonary function tests measure the lungs’ ability to move air in and out.
- Chest X-ray uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film or digital media.
- Computerized tomography (CT- scan) uses a combination of X-rays and computer technology to produce horizontal, or axial, images of any part of the body, including the bones, muscles, fat, and organs.
- Echocardiogram is a noninvasive procedure used to assess the heart's function and structures.
- Electrocardiogram (EKG) measures the electrical signals that control heart rhythm.
- Cardiac stress test may be ordered if you have or are suspected of having coronary artery disease. This test evaluates your heart’s response to stress or exercise.
- Blood tests
For many patients with pectus excavatum, there are no symptoms other than the sunken appearance of the chest and no treatment is required other than regular checkups with your doctor. For some patients, especially those who are born with this condition, the symptoms slowly develop as they get older and do not cause any problems until adulthood. When the function of the heart or lungs is compromised, or the patient’s breathing or posture is affected, surgery is recommended. Minimally invasive surgical treatments for pectus malformation are:
- Highly modified Ravtich technique removes cartilage and elevates the breastbone with two stainless steel struts inserted through a small vertical incision in the mid-chest.
- Nuss procedure, a type of VATS (video-assisted thoracic surgery) generally used for adolescent patients. A curved steel bar (known as the Lorenz Pectus Bar) is inserted through two small incisions under the sternum. It pushes out the depression and is then fixed to the ribs on either side.
Pectus carinatum often does not need treatment. When the condition is severe and causing medical issues or emotional distress, the following treatments are available:
Minimally invasive surgery may be performed to improve the appearance of the chest. Techniques include:
- Osteomy: Small bone cuts in the breastbone smooth out the contour and resolve rotation of the bone.
When you become a patient at The Lung Center, you will meet with many members of the team and you will receive a comprehensive evaluation and monitoring. Your medical team will recommend treatment tailored just for you.
Pectus malformation patients benefit from the wide range of specialists at The Lung Center, including pulmonologists, thoracic surgeons, cardiovascular medicine physicians and thoracic imaging experts. This collaboration ensures comprehensive evaluation of pectus malformation, as well as targeted treatment for pectus excavatum.
Any surgery recommended will be performed by an experienced, board-certified thoracic surgeon. You will receive care from a team including nurses and physician assistants who will help you recover quickly.
Go to our online health library to learn more about thoracic diseases and tests.
Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.
This page was last modified on 8/18/2016