What is a funnel shaped chest? A deeper look into Pectus Excavatum
A funnel shaped chest, or pectus excavatum, is a common chest wall deformity where the breastbone (sternum) and the attached ribs grow inward, creating a sunken appearance. This indentation can be symmetrical or asymmetrical and often becomes more noticeable during adolescence. The condition results from abnormal growth of the costal cartilages that connect the ribs to the sternum, causing the sternum to be pushed inward. This can affect the third to seventh ribs, with the lower sternum often showing the most significant depression.
Causes and risk factors
The precise cause is not fully understood, but it is thought to be a combination of genetic and environmental factors. A family history of the condition suggests a genetic link. Pectus excavatum can also be associated with other conditions such as Marfan syndrome, Ehlers-Danlos syndrome, scoliosis, and Poland syndrome.
Symptoms and severity
Symptoms vary with severity. Mild cases may only be a cosmetic concern. More severe cases can impact internal organs, leading to:
- Breathing difficulties due to compressed lungs.
- Cardiovascular issues, including palpitations and reduced exercise tolerance, if the breastbone presses on the heart.
- Chest and back pain.
- Fatigue from reduced heart and lung function.
- Emotional distress, self-consciousness, and anxiety, particularly in adolescents, due to the visible deformity.
Diagnosing pectus excavatum
Diagnosis starts with a physical exam. To assess severity and impact on organs, tests may include:
- CT or MRI scans for detailed imaging.
- Echocardiogram to check heart function.
- Pulmonary Function Tests (PFT) to measure lung capacity.
- Cardiopulmonary Exercise Test (CPET) to assess exercise tolerance.
Treatment options for funnel shaped chest
Treatment depends on severity and symptoms.
Nonsurgical treatments
- Vacuum Bell Therapy: Uses suction to lift the breastbone and is often effective for younger patients with flexible chests.
- Physical Therapy: Can improve posture and strengthen muscles to potentially minimize the appearance.
Surgical options
- The Nuss Procedure: Minimally invasive, using a metal bar to reshape the chest, typically removed after several years.
- The Ravitch Technique: An open surgery to remove deformed cartilage, reposition the sternum, and support it with a bar that is later removed.
Comparison of Nuss vs. Ravitch Procedure
| Feature | Nuss Procedure | Ravitch Technique |
|---|---|---|
| Invasiveness | Minimally invasive | Open surgery |
| Incisions | Small, on the side of the chest | Larger, horizontal across the chest |
| Age group | Often preferred for adolescents | Can be used for all ages |
| Recovery time | Often quicker initial recovery | Longer recovery due to more extensive reshaping |
| Bar removal | Required after 2–3 years | Required after 6–24 months |
| Chest wall stability | Intact initially | Requires time for cartilage to regrow |
The importance of evaluation
A medical evaluation is essential to determine the best treatment approach, addressing both physical and emotional concerns. Consulting a specialist, such as a thoracic or pediatric surgeon, is recommended. Successful treatment can improve cardiopulmonary function and self-esteem. For more information, you can refer to the American Association for Thoracic Surgery.
Conclusion
A funnel shaped chest, or pectus excavatum, is a common chest wall deformity. While often cosmetic, it can cause physical symptoms in more severe cases by compressing the heart and lungs. Treatment options range from non-invasive vacuum bell therapy to surgical procedures like the Nuss and Ravitch techniques. A thorough medical evaluation is key to determining the appropriate treatment plan for each individual, focusing on both physical health and psychological well-being.
