Understanding Pectus Excavatum: The Cause of a Sunken Chest
Pectus excavatum, often referred to as "funnel chest," is a congenital (present at birth) chest wall deformity. It involves an abnormal overgrowth of the cartilage connecting the ribs to the breastbone (sternum), causing the sternum to sink inward and creating a visible depression. This condition is more common in males than females and can worsen during adolescent growth spurts.
While the exact cause is not definitively known, recent evidence points toward a genetic component, as it can run in families. In some cases, it can be an isolated finding, but it may also be associated with other genetic or connective tissue disorders like Marfan syndrome, Ehlers-Danlos syndrome, or scoliosis.
Different Severities and Associated Symptoms
The severity of pectus excavatum can vary widely. For many people, the indentation is mild and purely cosmetic, causing no physical symptoms. For others, particularly those with a moderate to severe deformity, the condition can exert pressure on the heart and lungs.
Symptoms associated with more severe cases can include:
- Cardiopulmonary issues: Shortness of breath, fatigue, reduced exercise tolerance, and a rapid or irregular heartbeat (palpitations).
- Chest pain: Discomfort or pressure in the chest area.
- Recurrent respiratory infections: Increased susceptibility to respiratory illnesses.
- Postural changes: The chest deformity may lead to a hunched-forward posture with rounded shoulders.
- Psychological impact: The cosmetic appearance of the condition can cause significant psychological distress, low self-esteem, and social anxiety, particularly during adolescence.
Diagnosis and Evaluation
Diagnosing pectus excavatum typically begins with a physical examination. A healthcare provider will evaluate the depth of the indentation and check for other signs. To assess the severity and potential impact on internal organs, additional tests may be recommended:
- Computed Tomography (CT) Scan: Provides detailed cross-sectional images of the chest. It is used to calculate the Haller index, a numerical ratio that measures the severity of the deformity by comparing the width of the chest to the distance between the sternum and the spine. A Haller index over 3.2 is often considered severe.
- Echocardiogram: An ultrasound of the heart to evaluate its structure and function. It can determine if the sternum is compressing or displacing the heart.
- Pulmonary Function Tests (PFTs): Measure how well the lungs are working. In severe cases, the restricted chest volume can reduce lung capacity.
- Cardiopulmonary Exercise Test (CPET): Evaluates heart and lung function during physical exertion to assess exercise tolerance.
Treatment Options for Pectus Excavatum
Treatment for pectus excavatum is not always necessary and depends on the severity and presence of symptoms. For mild cases without symptoms, close observation is often recommended.
| Treatment Method | Description | Primary Goal | Best For | Considerations |
|---|---|---|---|---|
| Vacuum Bell Therapy | A non-surgical device that uses suction to gradually lift the breastbone over time. | Cosmetic improvement, potentially reversing mild defects. | Younger individuals with flexible chest walls and mild defects. | Requires daily use for an extended period (1–2 years or more). |
| Nuss Procedure | A minimally invasive surgery where a curved metal bar is placed under the sternum to push it outward. | Correcting moderate-to-severe defects and improving heart and lung function. | Typically teens and young adults with significant symptoms. | Hospital stay required, bars stay in place for 2–3 years, potential for pain. |
| Ravitch Technique | An open surgical procedure involving the removal of deformed cartilage to reposition the sternum. | Correcting severe or complex defects, especially in older patients or those with asymmetry. | Less common now, used for complex cases. | More invasive, longer recovery, potential for hardware. |
| Physical Therapy | Specific exercises to improve posture and strengthen chest muscles. | Improving posture and minimizing the appearance of the deformity. | Often used in conjunction with other treatments. | Non-corrective alone, but supportive. |
| Cosmetic Fillers | Injectable materials or implants to fill the depression. | Improving cosmetic appearance without surgical correction of the bone structure. | Individuals with mild, asymptomatic defects concerned about appearance. | Purely cosmetic, does not address underlying bone structure. |
When to See a Doctor
While a mild indentation may not be a medical concern, it is important to consult a healthcare provider if you or a child has a sunken chest, especially if you notice any of the following:
- The depression appears to be getting deeper.
- Chest pain or pressure.
- Shortness of breath, especially during exercise.
- Fatigue or decreased exercise endurance.
- Palpitations or a rapid heartbeat.
- Significant psychological distress or self-consciousness about the appearance of the chest.
Conclusion
A "hole" in the middle of the chest is a common description for pectus excavatum, a chest wall deformity caused by inward growth of the sternum. Its significance ranges from a cosmetic concern to a medical issue that can affect heart and lung function. A proper diagnosis and evaluation by a medical professional can determine the severity of the condition and guide the most appropriate treatment plan, ensuring that all aspects—from physical health to psychological well-being—are addressed. For additional information on genetic considerations, you can visit the National Institutes of Health website.
