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What Is Pectus Excavatum?
Pectus excavatum — also known as concave chest, cobbler's chest, funnel chest, or sunken chest — is a congenital chest wall anomaly. It happens when the rib cage and sternum (breastbone) grow inward, making the chest look caved in, concave, or sunken.
This condition can be present at birth or develop later. Sometimes, it isn't noticeable until puberty, and it can worsen during growth spurts. The condition usually stops getting worse once a child stops growing.
Pectus excavatum can either be mild or severe. In general, mild cases don't cause symptoms. But in severe cases, pectus excavatum can affect the heart and lungs, causing symptoms, such as shortness of breath and heart palpitations, and making exercise a challenge. Some people may experience emotional or mental health issues because of how their chest looks.
Surgery can help repair pectus excavatum, improving the look of the chest and relieving symptoms.
What Causes Pectus Excavatum?
The exact cause is unknown. It can run in families, although there's no known genetic link to the condition. Pectus excavatum also can occur without a family history of the condition.
Abnormal development of the ribs or the cartilage that connects the sternum and ribs may also cause pectus excavatum.
Though most cases of pectus excavatum are seen in healthy children, it can occur in association with other health conditions, including:
- Ehlers-Danlos syndrome.
- Marfan syndrome.
- Neurofibromatosis type 1.
- Noonan syndrome.
- Osteogenesis imperfecta.
- Poland syndrome.
- Rickets.
- Scoliosis.
- Spinal muscular atrophy.
- Turner syndrome.
What are the risk factors and complications of pectus excavatum?
Pectus excavatum risk factors
Risk factors of pectus excavatum include:
- Abnormal cartilage development — An irregular development of the cartilage that connects the sternum and ribcage.
- Family history — Pectus excavatum can run in families.
- Other health conditions — Certain health conditions have been linked with pectus excavatum.
- Sex — Males are more likely to have pectus excavatum than females.
Complications of pectus excavatum
Severe cases of pectus excavatum can cause heart and lung problems. In these cases, treatment — including surgery — is recommended.
For some people, how pectus excavatum makes their chest look can also cause mental health, body image, or self-esteem issues.
How common is pectus excavatum?
Pectus excavatum is the most common congenital chest wall anomaly. It affects anywhere from 1 in 300 to 1 in 1,000 births.
Males are three to five times more likely to have pectus excavatum than females.
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What Are the Signs and Symptoms of Pectus Excavatum?
The clearest sign of pectus excavatum is an abnormal-looking chest and ribcage.
People with pectus excavatum typically have a sunken-looking chest in the sternum area. Depending on how severe the condition is, this depression may be shallow or deep.
Pectus excavatum also can cause a condition called rib flare, where the lower ribs stick out.
In severe cases, pectus excavatum can press on the heart and lungs. This pressure can lead to symptoms like:
- Asthma.
- Chest pain.
- Dizziness.
- Exercise intolerance.
- Fatigue.
- Heart murmur.
- Heart palpitations.
- Irregular heartbeat.
- Shortness of breath.
When should my child see a doctor about pectus excavatum symptoms?
You or your child should see a doctor if pectus excavatum is causing symptoms related to the heart and/or lungs. You can begin with a visit to a primary care physician or your child's pediatrician. They may refer you to a pediatric thoracic (chest) surgeon for surgical evaluation if needed.
People may also benefit from seeing a mental health specialist if their condition is causing them body image or self-esteem issues.
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How Do You Diagnose Pectus Excavatum?
Doctors can often diagnose pectus excavatum with a physical examination of the chest. Primary care doctors, pediatricians, pulmonology specialists, and thoracic surgeons can diagnose the condition.
In addition to performing a physical exam, the doctor may order blood tests to help confirm the diagnosis. They'll ask about symptoms and may order other tests to see how the condition is affecting the heart and lungs.
Tests to diagnose pectus excavatum
Tests to diagnose pectus excavatum and assess its impact on the heart and lungs may include:
- Chest CT scan or MRI — Can show if pectus excavatum is compressing the heart or lungs.
- Chest x-ray — Can show if pectus excavatum is displacing the heart.
- Echocardiogram — Provides imaging of the heart.
- Electrocardiogram — Measures the heart's electrical activity.
- Exercise stress tests — Measure a person's ability to tolerate exercise.
- Genetic tests — Diagnose whether you have any genetic conditions related to pectus excavatum.
- Pulmonary function tests —Indicate how well the lungs are working and may diagnose problems.
Pectus excavatum prognosis
Depending on the severity of their condition, people with pectus excavatum can live healthy lives. People with minor cases may not need surgery, and physical therapy can help strengthen chest muscles.
More severe cases can cause problems with the heart and lungs. People may have trouble exercising or doing daily tasks, which is why surgery often is recommended for more severe cases.
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How Do You Treat Pectus Excavatum?
Talk to the doctor about which treatment your child should get for pectus excavatum. If it's a minor case, they may not need treatment, but physical therapy exercises may help. If the condition is severe and/or is affecting the heart or lungs, they may need surgery.
Also, if they have emotional stress from the look of their chest, surgery or other treatment could help improve their chest's appearance.
If they are a candidate for surgery, the main surgical option for pectus excavatum is the minimally invasive Nuss procedure. A pediatric thoracic surgeon performs the surgery.
In rare cases, surgeons may perform the Ravitch procedure. The Ravitch procedure is more invasive, requiring a large chest incision. It is typically used in cases where pectus excavatum recurs.
Nonsurgical options for pectus excavatum
- Physical therapy — For minor cases of pectus excavatum, exercises focusing on the chest and core can help strengthen chest muscles and improve posture.
- Vacuum bell device — This device improves the look of the chest and is generally used in younger people with minor severity of pectus excavatum. You wear the device, which is connected to a hand pump, on your chest. Using the hand pump provides negative pressure to pull the chest forward. Daily use of the device over a span of months may improve minor cases of pectus excavatum.
Surgery for pectus excavatum
Surgery can both improve the look of the chest and relieve symptoms of pectus excavatum. It can also improve the ability to tolerate exercise.
Nuss procedure
The Nuss procedure is a minimally invasive thoracoscopic option for pectus excavatum. A surgeon makes two small cuts on either side of the chest, then inserts a curved metal bar underneath the sternum and attaches it to the ribs. Depending on the severity of the condition and patient's age, the surgeon may use two or three bars.
Over time, the steel bar fixes the shape of the chest. The bar typically remains in place for three years before the surgeon removes it during an outpatient procedure.
It may take weeks or months to return to normal activity after the Nuss procedure. The person may need pain medication after the procedure and may also have to avoid certain activities that could cause trauma to the chest. They can return to sports and other physical activities over the course of six months.
What are the risks and complications of pectus excavatum surgery?
Any surgery carries possible risks, such as bleeding and infection. Risks or complications associated with pectus excavatum surgery include:
- Bar displacement.
- Chronic pain.
- Heart or lung damage.
- Hemothorax (collection of blood between the lungs and chest wall).
- Pleural effusion (buildup of fluid between the lungs and the chest wall).
- Pneumothorax (collapsed lung).
How long does it take to recover after surgery for pectus excavatum?
Recovery after pectus excavatum surgery may take weeks to months. People typically stay in the hospital for at least a few days after the procedure.
The person may need to take medication to reduce the amount of pain after the procedure and stay home from work or school for a few weeks. Their doctor also may recommend avoiding certain activities, such as driving.
The patient may need several outpatient visits in the weeks and months after the procedure to help ensure there are no complications.
They can return to physical activity over the course of six months:
- For the first two weeks, they should have limited mobility.
- From two to six weeks post-procedure, they can begin to increase your arm mobility.
- From six weeks to three months post-procedure, they can return to normal activities with the exception of sports and exercise.
- At three months, they can return to noncontact sports like running.
- At six months, they can return to full activity, including contact sports.
After about three years, they will have the bar removed.
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Why Choose UPMC for Pectus Excavatum Care?
UPMC provides world-class care for pectus excavatum and other chest wall conditions.
At UPMC, you can expect:
- Access to cutting-edge treatments — We provide the most advanced treatments for pectus excavatum, including the latest surgical techniques.
- Comprehensive care — We offer a full spectrum of care, from diagnosis to management and treatment.
- Experienced clinicians — Our care teams have years of experience in treating pectus excavatum, giving you expertise you can trust.
- Individualized treatment plans — We will tailor your treatment to your individual case, determining the best path forward for you.
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Last reviewed by Shawn Safford, MD on 2024-11-04.
