What is a dip in the center of your chest?
A dip or concave appearance in the center of the chest is most commonly known as pectus excavatum, often called 'funnel chest' or 'sunken chest'. This chest wall deformity happens because of abnormal growth in the cartilage connecting the ribs to the sternum. This excess growth pushes the sternum inward, causing the indentation. While present from birth, the dip may become more noticeable during adolescent growth spurts.
The Primary Cause: Pectus Excavatum
The exact cause of pectus excavatum is not completely understood, but it's thought to be a mix of factors. One idea is that irregular connective tissue growth displaces the sternum. Genetics also seem to play a role, as nearly half of people with the condition have a family history of it. Pectus excavatum can also be linked to other genetic and connective tissue conditions:
- Marfan syndrome
- Ehlers-Danlos syndrome
- Noonan syndrome
- Scoliosis
Other Potential Considerations
Other less common medical or skeletal issues can sometimes cause a caved-in chest appearance or feeling. A medical evaluation is important to confirm the diagnosis and rule out other potential causes.
Symptoms Associated with Pectus Excavatum
Many individuals with mild pectus excavatum only have cosmetic concerns. However, those with moderate to severe indentations may experience symptoms because the inward chest pressure can affect the heart and lungs.
Physical symptoms can include:
- Shortness of breath, especially during physical activity.
- Fatigue and decreased stamina.
- Chest discomfort.
- Rapid or irregular heartbeat.
- Heart murmur.
- Frequent respiratory infections.
Pectus excavatum can also impact self-esteem, particularly during adolescence, leading some individuals to avoid activities that expose their chest.
Diagnosing the Condition
Diagnosis typically starts with a physical exam. To determine severity and its effect on internal organs, further imaging tests are often needed. These can include:
- CT Scan or MRI: These tests assess heart and lung compression and help calculate the Haller Index, a measure of the deformity's depth.
- Echocardiogram: An ultrasound to evaluate heart function.
- Pulmonary Function Tests: Measure lung capacity.
- Exercise Stress Testing: Evaluates exercise tolerance.
Comparison of Pectus Excavatum Severity
Treatment for pectus excavatum depends on how severe it is and if there are symptoms. The table below compares mild and severe cases based on diagnostic findings and symptoms.
| Feature | Mild Pectus Excavatum | Severe Pectus Excavatum |
|---|---|---|
| Appearance | Subtle dip; often purely cosmetic. | Deep, visible hollow; can be asymmetrical. |
| Physical Symptoms | Generally asymptomatic. | Shortness of breath, fatigue, chest pain, palpitations, reduced exercise tolerance. |
| Haller Index | Often below 3.25. | Typically 3.25 or higher, indicating more significant compression. |
| Impact on Organs | Minimal to no compression of heart or lungs. | Can displace the heart and restrict lung expansion. |
| Psychological Impact | May cause self-consciousness. | Can lead to significant emotional distress and social avoidance. |
| Recommended Treatment | Observation, physical therapy, vacuum bell therapy. | Often requires surgical correction (Nuss or Ravitch). |
Treatment Options for a Sunken Chest
Treatment plans are usually based on the severity of the condition. Mild cases may only require monitoring, while severe cases may need intervention to relieve pressure on the heart and lungs.
Non-Surgical Approaches
- Observation: Mild cases in young children with few symptoms may just be monitored over time.
- Physical Therapy: Exercises to improve posture and strengthen chest muscles can help in some cases.
- Vacuum Bell Therapy: This non-invasive method uses a suction cup to gradually pull the sternum outward. It works best for younger patients with more flexible chest walls.
Surgical Procedures
For moderate to severe cases, especially those causing physical symptoms, surgery is often recommended. The two main surgical methods are:
- The Nuss Procedure: A minimally invasive technique where a metal bar is inserted to push the sternum into a normal position. The bar is removed after several years.
- The Ravitch Procedure: A traditional open surgery that removes the excess cartilage causing the indentation. Sometimes, a temporary metal strut is used to hold the sternum in place.
Conclusion: When to See a Doctor
If you have a dip in your chest along with symptoms like chest pain, shortness of breath, or reduced exercise capacity, it's important to see a healthcare professional for a diagnosis. A mild dip might be cosmetic, but a more severe one could impact heart and lung function. Pectus excavatum's effects vary, and medical advice is the best way to determine the appropriate steps, from observation to treatment. For more information, you can find resources on the Johns Hopkins Medicine website.
