What does a severe case of pectus excavatum look like?

September 27, 2025 •

2 min read

Pectus excavatum, also known as 'funnel chest,' affects approximately 1 in 400 births, and its severity can range dramatically from a minor cosmetic concern to a serious health issue. This congenital chest wall deformity, caused by an inward growth of the sternum and ribs, often worsens during adolescent growth spurts. Understanding what does a severe case of pectus excavatum look like is crucial for proper diagnosis and treatment planning.

Quick Summary

A severe case of pectus excavatum presents as a deep, visibly sunken chest, which may be asymmetrical and accompanied by flared ribs and poor posture. The inward-growing sternum can compress and displace the heart and lungs, leading to significant cardiopulmonary symptoms, such as decreased exercise tolerance, chest pain, and heart palpitations. This condition is also associated with considerable psychosocial distress, impacting self-image and quality of life.

Key Points

Visual Deformity: A severe case of pectus excavatum involves a deep, often asymmetrical, inward depression of the sternum and rib cage, sometimes accompanied by flared ribs and poor posture.
Cardiopulmonary Effects: The sunken chest can compress the heart and lungs, leading to symptoms like decreased exercise tolerance, shortness of breath, fatigue, chest pain, and heart palpitations.
Haller Index for Measurement: A clinical diagnosis of severe pectus excavatum is confirmed with a chest CT scan, which calculates the Haller index; a value greater than 3.5 signifies a severe deformity.
Beyond Physical Symptoms: The condition also carries a significant psychosocial burden, with many patients experiencing body image issues, anxiety, and depression, regardless of the objective physical severity.
Surgical Intervention: Surgical correction, such as the Nuss or Ravitch procedures, is often recommended for severe cases to alleviate cardiopulmonary symptoms and improve quality of life.
Diagnostic Process: A thorough evaluation for severe pectus excavatum includes a physical exam, CT scan, echocardiogram, and pulmonary function tests to determine the extent of the impact.

Defining a severe case

While a mild case of pectus excavatum may be barely noticeable, a severe case is clinically defined by significant physiological and anatomical features. The Haller index, calculated from a chest CT scan, is a key diagnostic tool. A Haller index greater than 3.25 typically indicates moderate to severe deformity and thoracic compression.

The visual characteristics

Severe pectus excavatum involves a deep, often asymmetrical chest indentation, sometimes described as 'scooped-out' or 'trench-like'. Individuals may also exhibit a hunched posture and rib flare.

The physiological impact

The sunken sternum in severe cases can compress the heart and lungs, reducing lung capacity and displacing the heart. This can lead to various symptoms.

Cardiopulmonary symptoms of severe pectus excavatum

Decreased exercise tolerance: Fatigue during physical activity.
Shortness of breath: Difficulty breathing during exertion.
Heart palpitations or rapid heartbeat: Irregular or rapid heartbeats.
Chest pain: Discomfort in the chest.
Fatigue and dizziness: Tiredness and lightheadedness, particularly when standing.
Heart murmur: A compromised heart valve may be detected.

Diagnosis and assessment

Diagnosis involves a physical examination and specialized tests to assess both structural and functional impacts.

Diagnostic methods

CT Scan: Used to measure the Haller index and assess heart displacement and lung compression. Low-dose protocols are used for children.
Echocardiogram (Cardiac Ultrasound): Evaluates heart function and identifies compression-related issues.
Pulmonary Function Tests (PFTs): Measure lung capacity and breathing efficiency.
Exercise Stress Test: Monitors heart and lung function during exercise.

Comparison: mild vs. severe pectus excavatum

Distinguishing between mild and severe cases requires a clinical evaluation. Key differences are highlighted below.


Feature	Mild Pectus Excavatum	Severe Pectus Excavatum
Physical Indentation	Slight, often shallow.	Deep, "scooped-out" or "trench-like".
Associated Posture	Typically normal or minor issues.	Hunched-forward posture with rounded shoulders and potential scoliosis.
Cardiopulmonary Function	Generally asymptomatic; normal.	Significant compromise, especially during exertion.
Exercise Tolerance	Normal.	Decreased tolerance, fatigue, shortness of breath, and palpitations.
Haller Index (on CT)	Ranges from 2.0 to 3.2.	Greater than 3.5.
Psychological Impact	Variable; self-consciousness may exist.	Significant distress, including social anxiety and poor body image.

The psychosocial dimension

The psychological impact can be significant, even in mild cases, but is often a major concern in severe cases. Patients frequently report body image issues, social anxiety, and reduced quality of life. This can lead to avoidance of certain activities and impact social development. Psychological well-being is an important part of patient evaluation.

The path forward: treatment for severe cases

Surgical correction is often recommended for severe cases with significant symptoms. Common procedures include the Nuss and Ravitch techniques. Surgery can lead to improvements in both physical symptoms and quality of life. For more medical information, consult a reliable source such as the National Institutes of Health.

Frequently Asked Questions

Doctors use a physical exam and a chest CT scan to measure severity. The CT scan is used to calculate the Haller index, a ratio of the chest's width to its depth at the deepest point of the sternal depression. A Haller index over 3.5 is considered severe.

Yes, pectus excavatum can worsen, especially during adolescent growth spurts. The inward growth of cartilage that pushes the sternum inward can become more pronounced as a person grows.

In severe cases, the depressed sternum and ribs can compress the heart and lungs. This reduces the lungs' capacity to expand and can displace the heart, impairing its ability to pump efficiently.

Common symptoms include decreased exercise tolerance, shortness of breath, fatigue, chest pain, and heart palpitations or a rapid heartbeat. In some cases, dizziness and recurrent respiratory infections can also occur.

For severe cases causing significant symptoms, surgical correction, such as the Nuss or Ravitch procedure, is often recommended. While less invasive options like vacuum bell therapy exist for milder cases, they are generally not sufficient for severe deformities.

No. A severe case can have a significant psychological impact, leading to poor body image, social anxiety, and depression. These issues can be present regardless of the objective physical severity and are a key consideration for treatment.

While some individuals may choose to not pursue treatment, severe pectus excavatum can lead to progressive cardiopulmonary compromise, limited physical activity, and considerable psychological distress. Surgical repair can often significantly improve both physical function and quality of life.

While specialized exercises focusing on core strength can help improve posture and reduce the appearance of rib flare, they cannot correct the underlying skeletal deformity associated with severe pectus excavatum.