What is Pectus Excavatum?
Pectus excavatum, also known as “funnel chest” or “sunken chest,” is the most common congenital deformity of the chest wall. It is characterized by an abnormal growth of the cartilage that connects the ribs to the sternum (breastbone), which causes the breastbone to be pushed inward. This can result in a depression in the center of the chest that varies in size and depth.
The condition can be mild, with only a slight depression that may not cause any health issues, or severe, where the indentation is deep enough to compress the heart and lungs. While present at birth, pectus excavatum often becomes more apparent during adolescent growth spurts as the chest wall develops rapidly. It is more common in males than in females.
Causes and Risk Factors
The exact cause of pectus excavatum is unknown, but a genetic component is suspected, as the condition can run in families. In about 25% of cases, there is a family history of chest wall abnormalities. It is sometimes associated with other conditions that affect connective tissue, suggesting an underlying link to genetic factors.
Risk factors associated with the development or occurrence of pectus excavatum include:
- Genetic predisposition: A family history significantly increases the likelihood.
- Connective tissue disorders: Marfan syndrome, Ehlers-Danlos syndrome, and osteogenesis imperfecta are some associated conditions.
- Genetic syndromes: Noonan syndrome and Turner syndrome are sometimes linked.
- Skeletal abnormalities: The condition can also coexist with scoliosis, a curvature of the spine.
Symptoms of Pectus Excavatum
The symptoms of pectus excavatum can differ depending on the severity of the condition. While some individuals with mild cases may not experience any physical symptoms, those with moderate to severe defects may notice certain signs.
Common physical symptoms
- Mild cases: The primary symptom is a cosmetic dip or dent in the chest.
- Moderate to severe cases: Physical symptoms can include:
- Shortness of breath, especially during physical activity or exercise
- Decreased physical stamina and exercise intolerance
- Rapid heartbeat or heart palpitations
- Chest pain or pressure
- Fatigue
- Recurrent respiratory infections
Psychological and emotional symptoms
For many, especially teenagers, the appearance of the chest can lead to significant psychological distress and self-image concerns. This can result in:
- Self-consciousness about their body shape
- Social anxiety and avoidance of activities like swimming
- Hunched-forward posture to conceal the depression
- Depression or anxiety
Diagnosis of a Chest Dip
Diagnosing pectus excavatum typically begins with a physical examination by a healthcare provider, who will assess the depth and symmetry of the chest wall deformity. If the condition is moderate to severe, additional tests may be ordered to evaluate potential impacts on the heart and lungs.
Diagnostic tests
- CT scan or MRI: These imaging tests provide detailed cross-sectional images of the chest, allowing doctors to measure the severity of the indentation using the Haller Index.
- Echocardiogram: An ultrasound of the heart to check its structure and function, ensuring there is no compression.
- Pulmonary function tests (PFTs): These tests measure lung capacity and function to determine if breathing is restricted.
- Electrocardiogram (ECG): May be used to check for heart rhythm irregularities.
Pectus Excavatum vs. Pectus Carinatum
While pectus excavatum is a caved-in chest, another related condition, pectus carinatum, is the opposite, with the sternum and ribs protruding outward.
| Feature | Pectus Excavatum | Pectus Carinatum |
|---|---|---|
| Appearance | Sunken, caved-in, or funnel-shaped chest | Protruding, pigeon-breasted, or bird-like chest |
| Cause | Overgrowth of rib cartilage pushes sternum inward | Overgrowth of rib cartilage pushes sternum outward |
| Frequency | More common (1 in 400 births) | Less common (1 in 1,200 births) |
| Symptoms | Shortness of breath, chest pain, exercise intolerance in severe cases | Often fewer physical symptoms, can cause shortness of breath during exercise |
| Associated Conditions | Marfan syndrome, scoliosis, Ehlers-Danlos syndrome | Marfan syndrome, scoliosis, congenital heart disease |
Treatment Options
Treatment for pectus excavatum depends on the severity of the condition and the presence of any symptoms. For mild cases, no treatment may be necessary. For more severe cases, or those with significant cosmetic or psychological concerns, several options are available.
Non-surgical treatments
- Vacuum Bell Therapy: A device is placed on the chest to create suction, pulling the sternum forward over time. It is most effective in younger patients with more flexible chest walls and is worn for several hours daily over an extended period.
- Physical Therapy: Certain exercises can help improve posture and chest muscle strength, which may alleviate some symptoms and improve appearance.
Surgical treatments
Surgery is typically recommended for moderate to severe cases, especially if heart or lung function is compromised.
- Nuss Procedure: A minimally invasive procedure where a custom-fitted metal bar is inserted under the sternum to push it forward. The bar remains in place for two to three years before being removed.
- Ravitch Procedure: An open surgery where the abnormal cartilage is removed, and the sternum is repositioned. A support bar may be used temporarily to hold the sternum in its new position.
The Emotional Impact and Long-Term Outlook
For many individuals, the cosmetic aspect of pectus excavatum is the most challenging part of living with the condition. Dealing with self-consciousness, bullying, and anxiety, particularly during adolescence, can have a significant emotional toll. Psychological support, alongside any medical treatment, is a crucial part of care.
The long-term outlook for people with pectus excavatum is generally very positive. With or without treatment, most individuals can live a full and normal life. For those with severe cases, surgical correction can significantly improve heart and lung function, as well as confidence and quality of life. Discussing treatment options with a qualified healthcare professional is the best way to determine the right path for your specific needs.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Please consult a healthcare professional for diagnosis and treatment.
For more information on chest wall deformities, visit the Cleveland Clinic website.
