What is pectus carinatum?
Often called "pigeon breast," pectus carinatum is caused when the sternum (breastbone) is pushed outward.
The forward protrusion of the sternum often causes pain during exercise or during times of increased respiratory effort. This abnormality is more common in boys (75%), and develops somewhat later in them than it does in girls. It increases in severity with age and generally worsens during growth spurts that occur during late childhood and adolescence.
Although pectus carinatum occasionally interferes with overall health, it generally should not interfere with cardiorespiratory (heart and lung) functioning.
What causes pectus carinatum?
The cause of this abnormality is unknown, but there may be a slight tendency to occur in families suggests that genetics may play a role. Excessive growth and structural abnormalities of cartilage (tough, connective tissue) of the ribs and sternum (breastbone) are present in pectus carinatum.
Also, it is seen in some inherited connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome, and in homocystinuria, which is a metabolic disorder.
When pectus carinatum is present in infancy, it is sometimes associated with premature fusion of segments of the sternum and ribs and congenital heart disease (Noonan syndrome).
What are the symptoms of pectus carinatum?
Children with pectus carinatum may not experience any physical symptoms. However, some children may occasionally have difficulties playing and exercising. They many have shortness of breath with activity or decreased endurance. Some may have tenderness and intermittent pain in the area of overgrown cartilages. Patients may also experience psychological distress and negative body image.
How is pectus carinatum diagnosed?
Physical examination is the primary way of diagnosis of pectus carinatum. Some patients undergo a chest X-ray during their initial evaluation. This helps the surgeon screen for other chest abnormalities or scoliosis.
A computed tomography (CT) scan may also be performed to define the anatomy of the chest. In severe cases with respiratory symptoms, a pulmonary function test may be performed to determine the degree to which lung function is compromised.
On rare occasions, an electrocardiogram (ECG or EKG) and an echocardiogram may be performed.
How is pectus carinatum treated?
Because the chest wall remains relatively flexible in young people until they reach early adulthood, wearing a brace over the carinatum deformity can push the chest wall down into a normal shape.
In children who have mild to moderate pectus carinatum and are highly motivated to avoid surgery, the use of a custom-fitted chest-wall brace pushing directly on the abnormal bone can produce excellent outcomes. Willingness to wear the brace as required is essential for the success of this treatment approach.
The brace works in much the same way as orthodontics (braces) works to correct the alignment of teeth. It consists of front compression plates that are anchored to bars that encircle the chest. This device can be hidden under clothing and it can be often worn over a very thin t-shirt for comfort. Girls cannot wear an underwire bra as this will cause pain and skin breakdown. The brace must be worn 23 hrs a day for the first months (or as many hours a day as possible) and is removed to shower or when participating in physical activities. The time of wearing the brace will decrease depending on the changes in the bone.
The brace will need to be adjusted frequently the first month of wear and then monthly until the retainer mode is accomplished. The child and parent will learn how to check to see if adequate pressure is being applied and evaluate the skin for any changes or breakdown. The brace will be adjusted monthly at the Pectus clinic.
The typical length of time needed to wear the brace for full correction will vary from person to person. On average, the brace will need to be worn for 6-20 months. As the Pectus decreases, the chest becomes a more normal shape, the brace will still need to be worn less often in “retainer mode”. Retainer mode means to decrease the hours and then decrease the number of days to eventually be able to discontinue use of brace. The pectus carinatum may recur when discontinued (many months), if so, restart use of brace.
Pectus carinatum surgery
In children who are not candidates for bracing, surgery may be necessary to restore normal chest contour.
Open surgery is performed through a horizontal incision on the anterior chest wall. The lower four to five cartilages that are abnormal are removed. This allows the cartilage to regrow in its new position.
The length of hospital stay following surgery is typically three to four days, but children often experience some discomfort for several weeks. Cosmetic and physical outcomes in children who have undergone surgery in mid-childhood or early adolescence are generally excellent.
More information about pectus carinatum care