Pediatric Pectus Excavatum (Sunken Chest)
Pectus excavatum often requires surgery. Pectus excavatum surgeons are committed to providing the best care for your child. Also known as “funnel chest”, pectus excavatum is an abnormal growth of rib cartilage that causes the sternum (breastbone) to protrude inward, resulting in a depression in the chest.
The condition may range from mild to severe and your child may or may not have symptoms related to the heart and lungs. Treatment is dependent on severity as well as symptoms and can range from simple observation to surgical repair.
It is not known why this happens but we do know it tends to occur in families, suggesting genetics may play a role. The condition occurs in at least 1 out of every 1,000 children and is more common in males. It may also be associated with Marfan Syndrome, Homocystinuria and Ehlers-Danlos Syndrome.
The child presents with depression of the sternal bone and may or may not have other symptoms. The most common symptoms are shortness of breath and/or decreased endurance with exercise. If present, occasionally the child will have an aching chest pain related to abnormal bone and cartilage growth.
Pectus excavatum often worsens with age and during growth spurts that occur in late childhood and adolescence. Some patients are very self-conscious because of the pectus excavatum deformity. Correction of the deformity may play a significant role in improving the self-esteem of some patients.
Tests and Diagnosis
To diagnose pectus excavatum, your child’s doctor will do a detailed physical examination. After diagnosis, additional testing for operative planning and identification of body system dysfunction, which may include the following tests:
- Computed Tomography (CT) Scan — This test uses X-rays to produce multiple images of the inside of the body. These three-dimensional pictures of the chest can show how severe the condition may be and if the heart and lungs are affected. The primary for the chest CT scan is to calculate a "Pectus Index" which measures whether the chest depression is mild or severe.
- Electrocardiogram (EKG) and/or echocardiography (ECHO) – These tests help the doctor see if your child’s heart is under any stress.
- Pulmonary (lung) function test (PFT) – This test helps the doctor see if your child’s lungs are under any stress.
- Dermal test – This test is for a skin allergy related to the metal used in the surgical procedure and maybe ordered by the surgeon if a metal skin allergy is suspected by your child's history.
- Chest X-ray - This X-ray test can be helpful to exclude any other problems within the chest itself.
Treatment of mild pectus excavatum can include exercises aimed at improving posture and upper body strength. If your child has moderate to severe pectus excavatum, surgery may be recommended. Most often, this surgery is recommended around age 13 but may be performed sooner or later depending on the individual patient needs.
- The Nuss procedure – This minimally invasive procedure usually requires a total of three small incisions located on both sides of your child’s chest. A curved metal bar shaped to your child’s chest is inserted under the ribs and is secured under the sternum to lift the chest. The bar is placed under observation using a small camera so the surgeon can watch the bar pass behind the sternum. The bar is left in place for three years to allow the chest rib to remold. The bar is then removed during outpatient surgery.
- The Ravitch procedure – This surgical procedure is for children and adolescents and is performed when bracing has not been successful. The procedure generally 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 pushed down and take its normal shape. 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.
Before and After
Pectus Excavatum Before
Pectus Excavatum After