Pectus excavatum is an abnormal inward curve to the breastbone. It may be visible at birth. Growth through adolescence can make the indentation of the chest more apparent. It may continue until it has created a bowl-shape dent in the center of the chest.

Severe forms can create extra pressure on the heart and lungs. This can lead to more serious health problems like shortness of breath and limited physical activities.

Causes

The exact cause of pectus excavatum is not known. Some theories include:

Pressure in womb during pregnancy
Excessive pulling on breastbone and rib cage from shortened tendons of diaphragm muscles
Abnormalities in cartilage of the rib cage
Genetic factors

The Rib Cage

Pectus excavatum may also be caused by conditions that affect connective tissue or chest structure, such as:

Scoliosis
Marfan syndrome
Ehlers-Danlos syndrome
Asphyxiating thoracic dystrophy (rare genetic disorder)

Risk Factors

Risk factors include:

Family history of pectus excavatum
Gender: more common in boys

Complications from pectus excavatum tend to increase with age due to bone growth and a decrease in the flexibility of the bones.

Symptoms

Pectus excavatum is characterized by an indentation in the front of the chest wall. It may be mild or deep enough to form a bowl shape.

If the indentation is severe enough to affect the heart or lungs you may also have:

Difficulty exercising
Unexplained shortness of breath
Mild chest pain
Frequent respiratory tract infections that last longer than normal

A person with this condition may not have any symptoms during childhood. But as the person grows into an adolescent, he may have symptoms because of of a more pronounced indentation in the chest wall.

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

Your doctor will often be able to diagnose pectus excavatum after a physical exam.

Additional tests may be done to find out if your heart or lungs are affected. These tests may include:

CT scan —a type of x-ray that uses a computer to make pictures of structures inside the chest. This is done to determine if the heart is squashed in the chest.
Pulmonary function test —a group of tests done to assess breathing ability. They will assess if your lungs have any difficulty moving adequate amounts of air.
Electrocardiogram (ECG, EKG)—a test that records the heart’s activity by measuring electrical currents through the heart muscle
Echocardiogram —a test that uses sound waves (ultrasound) to examine the size, shape, and motion of the heart

Treatment

Talk with your doctor about the best treatment plan for you. Options include:

Surgery

Surgery may be considered for those who:

Have impairments of the heart or lungs
Have difficulty with physical activity
Are uncomfortable with the appearance of your chest

The ideal age for this type of surgery is 7-14 years. But surgery can also be successful in adults, as well. There are 2 main surgical options:

Open Surgery (Ravitch Procedure)

This surgery involves incisions in the front of the chest. The surgeon will be able to see your breastbone. Some cartilage will be removed from your breastbone and nearby ribs. The surgeon will place the breastbone in its proper position. A metal strut and mesh will be used to support the new position. The metal strut may come out in 6-12 months.

Minimally Invasive Surgery (Nuss Procedure)

Small incisions are made on either side of the chest. The surgeon will place a metal bar through the incisions and secure it under the breastbone. This bar will push the breastbone into a better position. This bar will remain in the chest for 2-3 years. This will allow the chest time to remodel itself.

Exercise

Your doctor or physical therapist may recommend exercises or a rehabilitation program. Certain exercises and postural positions may decrease the appearance of mild pectus excavatum.

Prevention

There is no known way to prevent this condition.

RESOURCES:

American Pediatric Surgical Association
http://www.pediatricsurgerymd.org

Healthy Children—American Academy of Pediatrics
http://www.healthychildren.org

CANADIAN RESOURCES:

Canadian Association of General Surgeons
http://www.cags-accg.ca/

Health Canada
https://www.canada.ca

References:

Goretsky MJ, Kelly RE Jr, Croitoru D, Nuss D. Chest wall anomalies: pectus excavatum and pectus carinatum. Adolesc Med Clin. 2004;15(3):455-471.

Jaroszewski D, Notrica D, McMahon L, Steidley E, Descahmps C. Current management of pectus excavatum: a review and update of therapy and treatment recommendations. J Am Board Fam Med. 2010;23(2):230.

Mavanur A, Hight DW. Pectus excavatum and carinatum: new concepts in the correction of congenital chest wall deformities in the pediatric age group. Conn Med. 2008;72(1):5-11.

Pectus excavatum. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114889/Pectus-excavatum . Updated February 19, 2016. Accessed November 13, 2017.

Pectus excavatum. McMaster Children’s Hospital website. Available at:
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Accessed November 13, 2017.

Last reviewed November 2018 by EBSCO Medical Review Board Warren A. Bodine, DO, CAQSM
Last Updated: 7/13/2012

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