Why do I have a deep hole in my chest?

September 29, 2025 •

3 min read

Affecting up to 1 in 400 children, the condition known as pectus excavatum is a congenital deformity of the chest wall that causes the breastbone to sink inward. This is the most common reason for a deep hole in your chest and can range in severity from mild to impacting heart and lung function.

Quick Summary

The appearance of a deep hole in your chest is most often caused by pectus excavatum, a congenital chest wall deformity where the breastbone and rib cartilage grow inward. The condition can be mild or severe, and while it is often cosmetic, moderate to severe cases can affect cardiopulmonary function.

Key Points

Pectus Excavatum: A sunken chest appearance is typically caused by a congenital chest wall deformity called pectus excavatum, which means 'hollowed chest'.
Causes are Unknown: While the exact cause is unknown, it's often linked to an overgrowth of rib cartilage and can have a genetic component, running in families.
Severity Varies: The indentation can be mild and primarily a cosmetic concern, or severe enough to compress the heart and lungs, causing symptoms.
Physical and Emotional Symptoms: Physical symptoms include shortness of breath, fatigue, and chest pain, while psychological effects like low self-esteem and social anxiety are also common.
Treatment Options Exist: Options range from observation for mild cases to non-surgical methods like the vacuum bell for younger patients and surgical repair (Nuss or Ravitch procedure) for more severe cases.
Diagnosis is Comprehensive: Doctors use physical exams, CT scans, echocardiograms, and other tests to assess the severity and impact on organ function.

What is Pectus Excavatum?

Also known as "funnel chest" or "sunken chest," pectus excavatum is a structural abnormality resulting in a caved-in chest appearance. It occurs due to the abnormal growth of cartilage connecting the ribs to the breastbone, pushing the sternum inward. This congenital condition, present from birth, often becomes more noticeable during adolescent growth spurts. Severity varies from barely noticeable to a deep indentation impacting the chest cavity.

Causes and Associated Risk Factors

The exact cause is unknown but is thought to be from uncoordinated cartilage growth. A strong genetic link exists, with about 40% of those affected having a family history. Pectus excavatum can also be linked to conditions like Marfan syndrome, Ehlers-Danlos syndrome, Noonan syndrome, scoliosis, and Poland syndrome.

Symptoms and Complications

Symptoms can be physical and psychological, depending on the deformity's severity.

Physical Symptoms

Mild cases are mainly cosmetic. Deeper indentations can pressure the heart and lungs, causing shortness of breath, fatigue, chest pain, heart palpitations, and frequent respiratory infections.

Psychological and Self-Image Concerns

For many, especially adolescents, the visible deformity leads to low self-esteem, body image issues, social anxiety, and avoidance of activities exposing the chest. A hunched posture may also develop.

Diagnosis of Pectus Excavatum

Diagnosis involves a physical exam and medical history. Tests like chest X-rays or CT scans are used to calculate the Haller Index, measuring severity (above 3.25 is severe). An echocardiogram assesses heart function, pulmonary function tests measure lung capacity, and exercise stress tests evaluate heart and lung response to exertion. Genetic testing may be done if a connective tissue disorder is suspected.

Treatment Options for Pectus Excavatum

Treatment depends on severity. Mild cases without symptoms may not require treatment. Moderate to severe cases have non-surgical and surgical options.

Non-Surgical Treatments

Vacuum Bell Therapy: A device creates suction to pull the breastbone forward, most effective for younger patients with flexible chests.
Physical Therapy: Exercises and postural correction improve muscle strength and chest expansion.

Surgical Treatments

Surgery is for severe cases or when non-surgical methods fail. Main techniques include:

Nuss Procedure: Minimally invasive, using a metal bar inserted to push the sternum outward, remaining for years.
Ravitch Technique: Open surgery removing deformed cartilage and repositioning the breastbone with internal supports.

Comparison of Treatment Options


Feature	Vacuum Bell Therapy	Nuss Procedure	Ravitch Technique
Invasiveness	Non-invasive	Minimally Invasive	Open Surgery
Best for...	Younger patients, flexible chest walls, mild to moderate cases	Adolescents, moderate to severe cases	More severe/complex cases, adults
Recovery	Long-term daily use (12-15+ months)	A few days in hospital, several months activity restriction	Longer hospital stay, longer recovery and activity restriction
Scarring	None	Two small side incisions	Larger central chest incision
Duration of implant	N/A	2-3 years	~1 year

Is Pectus Excavatum Dangerous?

Mild pectus excavatum is usually not dangerous. Severe cases can compress the heart and lungs, potentially affecting function, though there's no evidence of reduced life expectancy. Untreated severe cases can worsen symptoms over time. Surgical repair can improve symptoms and quality of life. Consult a healthcare professional for concerns.

Conclusion

Understanding pectus excavatum is key to managing this common congenital chest wall deformity. While causes are unclear, it has physical and psychological impacts. Treatments range from observation and non-invasive therapies to effective surgical options. For more information, visit the American College of Surgeons website, https://www.facs.org/.

Frequently Asked Questions

Yes, many people with mild pectus excavatum live completely normal, healthy lives without any significant health issues. In severe cases, where heart or lung function is compromised, treatment may be necessary to manage symptoms and improve quality of life.

Pectus excavatum is believed to have a genetic component, as it often runs in families. Researchers have not identified a specific gene, but family history is a known risk factor.

Pectus excavatum can worsen during periods of rapid growth, such as during puberty. While the progression often stabilizes in adulthood, untreated severe cases can lead to increasingly noticeable symptoms as the body ages.

The Haller Index is a measurement used by doctors to determine the severity of pectus excavatum based on a CT scan. It is the ratio of the chest's width to its depth at the most indented point, with a higher number indicating a more severe deformity.

Vacuum bell therapy is a non-surgical treatment option that uses a suction device to create a vacuum over the chest, gently pulling the breastbone forward over a period of time. It is best suited for younger patients with a flexible chest wall.

In cases where pectus excavatum has been severely compressing the heart and lungs, surgical repair can improve cardiopulmonary function and lead to increased exercise tolerance. However, the primary goals and outcomes can vary between individuals.

While exercise cannot correct the underlying skeletal deformity, targeted exercises can strengthen surrounding muscles, improve posture, and increase chest expansion. This can help manage symptoms and improve the cosmetic appearance in some cases.