Chest Wall Deformity

Pectus Excavatum and Carinatum

Chest wall deformities include a spectrum of disorders that range from severely sunken in to severely protruded and every degree in between. Some can be so subtle that the deformity is not noticeable right away and may not require surgical correction. Surgeons at UPMC Children's Hospital of Pittsburgh specializing in pediatric care provide the two leading procedures to correct chest wall deformities.

Pectus Excavatum is a sunken or depressed condition of the sternum, which is the bone at the front of the rib cage. Although pectus excavatum is relatively common, it is not easily noticeable in milder cases. The deformity can cause physiological stress to internal organs. Often, the heart is compressed and the lungs have less space in which to ventilate. The heart is unable to fill completely because major veins can be kinked. Usually the patient has trouble breathing when physically active and has less stamina than other children.

Pectus Carinatum is nicknamed “pigeon chest” because it causes the ribs to protrude, looking bird-like. Pectus Carinatum does not typically involve the internal organs as pectus excavatum does, but there are physical complications to the deformity. In addition to altering the physical formation of the rib cage, sometimes pectus carinatum causes asymmetrical bone growth and protruding knobby lesions on the ribs.

Treatment Options

The pediatric surgeons at Children’s Hospital of Pittsburgh are experts on the latest techniques and technology for repairing both pectus excavatum and pectus carinatum including the Ravitch Procedure and the Nuss Procedure.

The Ravitch Procedure involves an incision to remove mangled cartilage and to repair, or reshape, the sternum. Both pectus excavatum and pectus carinatum can be corrected using this approach.

A more recent procedure, named the Nuss Procedure, is less invasive, but only available to repair pectus excavatum. Smaller incisions are made and a bar is used to push out the chest. The effect is similar to braces on the teeth. The chest can be remodeled in two years. The Nuss approach is popular because it is less invasive, but not all patients are eligible for this procedure.

How depressed or protruded a sternum is determines whether a child meets the criteria for surgery. The Ravitch procedure is typically performed between 13 and 22 years of age. The Nuss Procedure, because it is less invasive, can be performed from approximately 9 years and older.

Highly-qualified pediatric surgeons at Children’s Hospital assess and perform both procedures, providing relief and getting children back to normal lives.