Pectus Excavatum and Pectus Carinatum

Pectus excavatum and pectus carinatum are two common chest wall deformities that impact many people, often causing both physical and psychological discomfort.

Pectus excavatum is a condition where the breastbone is sunken into the chest, creating a concave appearance. This can impact the function of the heart and lungs and, in severe cases, can lead to reduced exercise tolerance and cardiovascular problems.

Pectus carinatum is characterized by an outward protrusion of the chest wall, resembling a bird’s chest. Although less likely to affect heart and lung function directly, this condition can cause substantial emotional distress and self-consciousness.

Both conditions can be treated in adults and children.

Risk factors

Common risk factors for pectus excavatum and pectus carinatum include a combination of genetic, developmental and environmental elements. Understanding these risk factors can help in early identification and management of these chest wall deformities.

Common risk factors include:

Genetic and family history

• Genetic predisposition: Both pectus excavatum and pectus carinatum tend to run in families, suggesting a genetic component. If you have a family member with either condition, your risk may be higher.
• Connective tissue disorders: Conditions such as Marfan syndrome and Ehlers-Danlos syndrome are often associated with higher incidences of chest wall deformities.

Developmental factors

• Growth spurts: Rapid growth during adolescence can exacerbate or contribute to the development of chest wall deformities.
• Prenatal development: Some chest wall deformities can be traced back to irregular developments in the fetal stage, affecting the growth patterns of the ribs and sternum.

Environmental and lifestyle factors

• Posture and physical activity: Poor posture or lack of physical activity can sometimes accentuate the appearance of chest wall deformities, although they are not direct causes.
• Nutritional deficiencies: Insufficient nutrients, especially during key growth periods, may play a role in the manifestation of these conditions.

Health history and other conditions

• Previous surgeries or trauma: Surgeries or physical trauma to the chest area can sometimes trigger or worsen the deformity.
• Respiratory issues: Chronic respiratory conditions during childhood, such as severe asthma or frequent lung infections, may contribute to the development of chest wall abnormalities.

While understanding these risk factors can provide insight into the potential development of pectus excavatum and pectus carinatum, it’s important to remember that these conditions can occur even in the absence of these factors.

If you suspect a chest wall deformity in yourself or a loved one, it is important to seek medical advice for a comprehensive evaluation and appropriate treatment plan.

Screening and diagnosis

Early screening is vital for timely and effective treatment.

For anyone with signs of chest wall deformities, a comprehensive evaluation can help diagnose the condition and determine its severity.

Diagnosis typically involves a combination of physical examination, imaging tests such as X-rays and CT scans, and pulmonary function tests to assess the extent of involvement of the internal organs.

Treatment

At WashU Medicine, our multidisciplinary team, including thoracic surgeons, cardiologists and pulmonologists work together to offer individualized treatment plans.

Both surgical and non-surgical options are available based on the severity of the condition and patient preference.

Non-surgical care

For milder forms of pectus carinatum, external bracing is often recommended, particularly in younger patients whose bones are still growing.

Regularly wearing the brace can gradually correct the chest wall’s shape for some people.

Surgical care

For more severe cases, surgical intervention is necessary. There are two main types of surgery for pectus excavatum and pectus carinatum.

• Ravitch procedure: This traditional open surgery involves making an incision across the chest, removing abnormal cartilage and repositioning the breastbone. This method is often chosen for older patients or when the deformity is particularly rigid.
• Nuss procedure: A minimally invasive technique where small incisions are made on the sides of the chest and a curved metal bar is inserted underneath the sternum. Over time, this bar is adjusted to correct the chest wall’s shape, typically remaining in place for two to three years.

Adult surgical repair

It is never too late to seek treatment. Adults can also benefit from surgical correction, though the procedures may be more complex.

WashU Medicine provides specialized care tailored to adult patients’ unique needs, ensuring a safe and effective treatment course.

Our pediatric surgeons typically treat chest wall deformities in children, while our adult thoracic surgeons provide care for adults with these conditions.

For adult appointments, please call 314-362-7260

For pediatric appointments, please call 314-454-6022

Risks and complications

While both the Ravitch and Nuss procedures are generally safe, potential complications can include infection, bleeding, bar displacement (in Nuss) and lingering pain.

However, the expert surgical team at WashU Medicine takes every precaution to minimize these risks and ensure successful outcomes.

Recovery

Recovery typically involves a hospital stay of several days for monitoring.

Patients are encouraged to gradually increase their physical activity as healing progresses, with full recovery typically achieved within a few months.

Continuous follow-up care is essential, including regular visits to monitor progress and manage any complications.

Lifelong monitoring and chronic conditions

Repairing chest wall deformities can significantly improve quality of life.

Some people with minor chest wall deformities may not require treatment, but might benefit from monitoring to be sure the condition does not affect their heart and lung health.

Chest wall deformities can make a person feel self-conscious. It can help to talk to someone about these feelings, even if you don’t need treatment for the condition.