Is Acquired Pectus Excavatum Real? Can pectus excavatum be caused by trauma?

September 27, 2025 •

4 min read

Over 90% of anterior chest wall deformities are congenital, with pectus excavatum being the most common. But can pectus excavatum be caused by trauma? This detailed guide explores how physical trauma can sometimes contribute to this condition.

Quick Summary

Physical trauma and previous chest surgeries can cause or worsen pectus excavatum, though it is most often a congenital condition linked to abnormal cartilage growth and genetics. It's an important distinction for diagnosis and treatment.

Key Points

Main Cause: Pectus excavatum is primarily a congenital condition caused by abnormal cartilage growth, often with a genetic link.
Acquired Cases: While less common, the condition can be acquired or worsened by significant physical trauma or previous chest surgery.
Distinguishing Origin: Doctors assess health history, including any chest injuries or surgeries, to help differentiate between congenital and acquired forms of the deformity.
Trauma's Role: Severe trauma, such as rib or sternal fractures, can create an acquired deformity or exacerbate an existing, mild congenital case.
Associated Conditions: Congenital pectus excavatum is sometimes linked to other genetic disorders, like Marfan or Ehlers-Danlos syndromes.
Surgical Trauma: Iatrogenic pectus excavatum can result from surgical interventions that damage chest wall growth centers, especially in young patients.

What is Pectus Excavatum?

Known commonly as “funnel chest,” pectus excavatum is a structural deformity of the chest wall where the breastbone (sternum) appears sunken or caved in. This condition is the most frequent congenital chest wall abnormality. It is caused by an overgrowth of the cartilage that connects the ribs to the sternum, which pushes the sternum inward. While present at birth, the deformity often becomes more prominent during adolescent growth spurts. For many, the condition is mild and only a cosmetic concern, but in severe cases, the sunken chest can compress the heart and lungs, leading to symptoms like shortness of breath, chest pain, and reduced exercise tolerance.

The Primary Cause: Congenital and Genetic Factors

While the exact cause of pectus excavatum is unknown, the overwhelming majority of cases are considered congenital and often have a genetic component. This means the condition is present at birth, even if it becomes more noticeable later. Key evidence for this includes:

Familial Tendency: Studies show that between 40% and 53% of patients have other family members with chest wall deformities, indicating a hereditary predisposition.
Associated Syndromes: Congenital pectus excavatum is more common in individuals with certain inherited musculoskeletal and connective tissue disorders, such as Marfan syndrome, Ehlers-Danlos syndrome, and Poland syndrome. These conditions involve abnormal connective tissue, which reinforces the genetic link.
Developmental Anomaly: The root cause is believed to be an abnormal and disproportionate growth of the costal cartilage (the cartilage that connects the ribs to the sternum), causing it to push the sternum inwards.

Can Pectus Excavatum Be Caused by Trauma? Evidence for Acquired Cases

Yes, although rare compared to congenital cases, physical trauma and previous chest surgeries can cause or worsen pectus excavatum. This is referred to as acquired pectus excavatum, which accounts for a very small percentage of all chest wall malformations.

Trauma from Accidents and Injuries

Direct or indirect trauma to the chest can lead to the development of a pectus excavatum-like deformity.

Severe Impact: Extensive trauma, such as a major car accident or a significant fall, can cause severe rib and sternal fractures. If these fractures heal improperly, they can result in a deformity that resembles pectus excavatum, known as a post-traumatic pectus deformity.
Flail Chest: An unstable, flail chest, which occurs from multiple consecutive rib fractures, can heal with a depression in the anterior chest wall, functionally creating an acquired pectus excavatum.
Iatrogenic Cases: In very specific medical situations, chest compressions during CPR, particularly in older adults with weaker skeletal structures, can cause enough structural damage to the sternum and ribs to result in an acquired chest wall depression.

Iatrogenic Trauma from Surgery

Acquired chest wall deformities, which are the largest group of all acquired deformities, can be caused by previous surgical interventions.

Growth Plate Damage: For younger patients, surgery involving extensive resection of rib cartilage, particularly near the sternal growth plates, can severely restrict chest wall growth. This can lead to a narrow, restricted, and deformed thorax, sometimes called acquired Jeune's syndrome.
Rib Graft Harvesting: The removal of a rib graft for another surgical procedure, if not performed carefully, can lead to chest wall abnormalities.

Congenital vs. Acquired Pectus Excavatum


Feature	Congenital Pectus Excavatum	Acquired Pectus Excavatum
Onset	Present at birth or early infancy, often worsening during adolescence.	Develops after a specific traumatic event or surgical procedure.
Primary Cause	Abnormal, uncoordinated growth of costal cartilage. Often linked to genetic factors.	External force from injury or previous surgery disrupting chest wall structure.
Symmetry	Can be symmetrical or asymmetrical, with varied shapes and depths.	Often localized to the specific site of the trauma or surgery.
Associated Conditions	Frequently associated with connective tissue disorders like Marfan syndrome or Ehlers-Danlos syndrome.	Primarily related to the specific injury or medical intervention that caused it.
Family History	A family history of chest wall deformities is common.	Typically no relevant family history, although pre-existing mild congenital pectus could be worsened.

Understanding the Role of Trauma in Diagnosis

When a patient presents with a sunken chest, a doctor will take a detailed health history to determine the likely cause. For a potential case of acquired pectus excavatum, questions will focus on any history of significant chest trauma, accidents, or previous thoracic surgeries. In contrast, for congenital cases, the physician will inquire about family history of similar deformities and look for signs of associated syndromes. Imaging tests, such as a CT scan, can help evaluate the extent of the deformity and whether it’s compressing internal organs, but the clinical history is crucial for understanding its origin.

Treatment Approaches

The distinction between congenital and acquired pectus excavatum can influence the treatment strategy. For acquired deformities resulting from trauma, the focus may be on reconstructing the damaged areas. For congenital cases, the timing of surgery (often around adolescence) and the choice between procedures like the Nuss or Ravitch depend on the severity and specific patient factors. Surgical techniques are tailored to the specific characteristics of the chest wall damage, whether developmental or traumatic.

Conclusion

While the vast majority of pectus excavatum cases are developmental and likely driven by genetic factors, trauma can indeed be a cause in rare, acquired instances. Significant chest injuries, particularly those causing fractures, or previous surgical interventions to the chest can lead to or exacerbate a sunken chest deformity. A comprehensive medical history is essential for physicians to determine the origin of the condition, as this information can influence the diagnostic evaluation and treatment plan.

For more detailed information on chest wall conditions, you can visit a reputable medical source such as Johns Hopkins Medicine.

Frequently Asked Questions

No, minor chest injuries are not a known cause. Acquired pectus excavatum is typically associated with significant, severe trauma, such as multiple rib or sternal fractures, that causes a major disruption to the chest wall structure.

Yes, some sources indicate that pre-existing, mild cases of pectus excavatum might be triggered or worsened by subsequent physical trauma or surgery to the chest area.

Specific types of trauma include blunt force impact leading to fractures of the sternum or ribs, major chest wall trauma resulting in a flail chest, or even certain surgical procedures (iatrogenic trauma) that interfere with normal chest wall development.

Diagnosis involves a detailed medical history and physical examination. The doctor will ask about the onset of the deformity and any history of chest trauma or surgery. Imaging tests, like CT scans, can provide further information about the underlying bone and cartilage structure.

Yes, the treatment approach may differ. For acquired cases, reconstruction of the damaged chest wall may be necessary. For congenital cases, surgical procedures like the Nuss or Ravitch techniques are common, depending on the severity of the developmental anomaly.

No, acquired chest wall deformities, including those from trauma, are rare, constituting less than 1% of all chest wall malformations.

In very rare and specific cases, typically involving older individuals, robust chest compressions have been documented to cause structural changes to the chest wall that result in an iatrogenic pectus excavatum deformity.