What is Pectus Excavatum?
Pectus excavatum, also known as funnel chest or cobbler's chest, is the most common congenital chest wall deformity. It involves the inward growth of the sternum and rib cartilage, creating a concave or caved-in appearance in the chest. While often present at birth, it can become more pronounced during adolescent growth spurts. The severity of the indentation varies greatly, and in significant cases, it can compress the heart and lungs, leading to physical symptoms and limitations.
Causes and Risk Factors
The precise cause of pectus excavatum remains unknown, but it is believed to result from abnormal rib cartilage growth. A genetic predisposition is often observed, with a family history reported in many cases. The condition is more common in males, with a male-to-female ratio of approximately 3:1.
Pectus excavatum is also associated with certain medical conditions, including Marfan syndrome, Ehlers-Danlos syndrome, Noonan syndrome, scoliosis, rickets, and Poland syndrome.
Symptoms and Complications
The symptoms of pectus excavatum are directly related to the depth of the chest indentation. Mild cases may have no symptoms other than the visible deformity. However, as the condition worsens, it can affect heart and lung function due to compression. This can result in symptoms such as shortness of breath, fatigue, chest pain, and heart palpitations. A heart murmur may also occur due to the heart's displacement. Poor posture, characterized by rounded shoulders, is also common. Beyond physical effects, the appearance of a sunken chest can lead to significant psychological distress, particularly in teenagers, contributing to body image issues, anxiety, and depression.
Diagnosis of a Sunken Chest
Diagnosis typically begins with a physical examination, where the chest deformity is usually evident. To assess the severity and potential impact on internal organs, a doctor may recommend several tests:
- CT scan: This imaging provides detailed cross-sectional images of the chest and is used to calculate the Haller index, a measure of severity. A Haller index above 3.2 is often considered indicative of severe pectus excavatum.
- Echocardiogram: An ultrasound of the heart to check its function and assess for compression or associated valve problems.
- Pulmonary function tests (PFTs): These tests measure lung capacity and efficiency to identify any respiratory limitations.
- Exercise stress tests: Used to evaluate how well the heart and lungs function during physical activity and to determine exercise tolerance.
Treatment Options
Treatment approaches for pectus excavatum are based on the severity of the condition and the presence of symptoms. Mild cases without symptoms may only require observation. For moderate to severe cases, both non-surgical and surgical interventions are available.
Nonsurgical Treatment
- Vacuum Bell Therapy: This non-invasive method uses a suction cup applied to the chest to gradually elevate the sternum over time. It's often effective for younger patients with flexible chest walls, although it may require several years of use.
- Physical Therapy: Targeted exercises can help improve posture and strengthen the muscles supporting the chest wall, potentially improving both appearance and function.
Surgical Treatment
Surgery is typically recommended for severe cases causing physical or psychological issues. It is often performed during the teenage years.
- Nuss Procedure: A minimally invasive technique where a metal bar is inserted under the sternum through small side incisions. The bar is then rotated to push the sternum outwards. It remains in place for 2-3 years before being surgically removed.
- Ravitch Procedure: A more traditional open surgery involving an incision across the chest. The surgeon removes abnormal cartilage and repositions the sternum, stabilizing it with a bar.
Pectus Excavatum vs. Pectus Carinatum
| Feature | Pectus Excavatum | Pectus Carinatum |
|---|---|---|
| Appearance | Sunken or caved-in chest; sternum appears depressed. | Protruding chest; sternum and ribs stick outward. |
| Common Name | Funnel chest or sunken chest. | Pigeon chest. |
| Primary Cause | Overgrowth of rib cartilage pushing the sternum inward. | Excessive cartilage growth pushing the sternum outward. |
| Impact | Can compress heart and lungs in severe cases, causing functional issues. | Less likely to affect heart and lung function directly; often a cosmetic concern. |
| Frequency | More common, affecting up to 1 in 400 births. | Less common, found in about 1 in 1,200 births. |
Conclusion
Pectus excavatum is a common chest wall deformity with varying degrees of impact. While mild forms may be primarily a cosmetic concern, more severe cases can significantly affect cardiopulmonary function, posture, and psychological well-being. Diagnosis involves physical examination and imaging tests to determine the severity and best course of treatment. Both non-surgical and surgical options, such as the Nuss procedure, can effectively correct the deformity and relieve associated symptoms. Consulting a medical professional is recommended to develop a personalized treatment plan and improve the quality of life for those affected by this condition.
Learn more about this condition by visiting the Mayo Clinic's overview of Pectus Excavatum.
