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Pediatric Pectus Carinatum (Pigeon Chest)

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Summary

Pectus carinatum is an abnormal growth of rib cartilage that pushes the sternum out, away from the spine. Also known as “pigeon chest”, pectus carinatum is identified by examination of the sternum (breastbone) which has a characteristic protrusion, causing the chest to grow outward. The condition rarely affects the function of the heart and lungs.

Causes

While the cause of this abnormality is unknown, the fact that it may occur in families suggests that genetics may play a role. Pectus carinatum may be associated with some inherited connective tissue disorders such as Marfan syndrome, homocystinuria and Ehlers-Danlos syndrome.

We are one of only a few centers in the United States with a clinic offering the Dynamic Compression Bracing System.

Symptoms

Pectus carinatum is usually noticed during a growth spurt between 12 and 14 years of age. It may not have any physical symptoms. Some patients complain of pain over the area where the cartilage is pushing on the breastbone. Some patients are very self-conscious because of the pectus carinatum deformity. Correction of the deformity may play a significant role in improving the self-esteem of some patients.

This condition is more common in boys, and tends to worsen in severity with age and during growth spurts that occur in late childhood and adolescence.

Diagnosis

To diagnose pectus carinatum, your child’s doctor will do a detailed physical examination.

Treatment

Bracing

Most children can be treated for pectus carinatum with bracing. The brace gently helps push the breastbone and remold the chest by applying measured, gentle pressure.  In a small percentage of children and when bracing is unsuccessful, an operation to correct the position of the breastbone is recommended. There are several types of bracing.  A Trulife® Circular Brace or a customized version called a Dynamic Compression Brace.

  • The Circular Brace - This type of brace is an off-the-shelf brace that is not customized.  The affected area must be centrally located for this brace to have optimum results.
  • Dynamic Compression Brace - This brace is designed with front compression plates anchored to bars that encircle the chest, and is custom-fabricated based upon measurements of your child’s chest. It is worn over a thin shirt, and hidden under regular clothing. Our center is one of the few in the United States with a dedicated team that has been trained to complete the customized measurements of the chest, supply the brace and provide follow up.

Your child must wear the brace, except for bathing, exercising or swimming, for between six to 20 months. During regular check-ups at our Pectus Clinic, the brace will be adjusted for comfort and compression. Initially, your child will wear the brace for a few hours a day, with that time gradually increasing to a max of 23 hours a day. As the chest begins to reach the desired shape, the wear time will then gradually decrease to retainer mode.

It is important to understand that best results come when a child wears the brace consistently and according to directions.

Surgery

  • The Ravitch procedure – This surgical procedure is for older children and adolescents and is performed when bracing has not been successful.

The procedure requires an incision across the chest. The surgeon will remove the abnormal rib cartilage between the boney ribs and the breast bone which allow the breast bone to be placed into its normal position. A metal bar will be placed in your child's chest to keep the breast bone in place. The bar is generally removed after 12 months during outpatient surgery.

Tests may be ordered to investigate for these conditions if the team feels like it is warranted. 

FAQ

If my child needs surgery, how long will she or he be in the hospital and when can she or he get back to normal activities?

Most hospital stays are three to seven days. Your doctor will explain the surgery option that is best for your child, along with all the details about how soon your child can be discharged, restrictions on activities and post-operative care and exercises. Typically, some activities are limited for six to 12 weeks as your child’s chest heals, but he or she can go back to school in about two weeks after surgery.

Resources

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