Chest Wall Disorder: Pectus Carinatum
What Is Pectus Carinatum?
Pectus carinatum is a genetic deformity of the chest wall in which the chest juts out. This happens because of an abnormal growth of rib and breastbone (sternum) cartilage.
The bulging gives the chest a birdlike appearance, which is why the condition is sometimes called pigeon breast or pigeon chest.
What Causes Pectus Carinatum?
Doctors don't know exactly what causes pectus carinatum (PEK-tus kair-ih-NOT-um). In some cases, it runs in families.
Kids who have it often have another health condition, such as:
- Down syndrome — a genetic disorder caused by the presence of all or part of an extra copy of chromosome 21
- Edwards syndrome — a genetic disorder caused by the presence of all or part of an extra 18th chromosome
- Marfan syndrome — a disorder that affects the body's connective tissue
- homocystinuria — a disorder that involves a problem with an amino acid that the body uses to make protein and build tissues
- Morquio syndrome — an abnormality in the growth, development, shape, or integrity of the bones and cartilage, most commonly resulting in dwarfism
- osteogenesis imperfecta — also known as brittle bone disease, this condition makes bones excessively fragile
What Are the Signs & Symptoms of Pectus Carinatum?
A pushed-out chest is the chief sign of pectus carinatum. This usually doesn't appear until a child is age 11 or older, even though the condition is present at birth.
The chest wall surrounds and protects the heart and lungs. So kids and teens with pectus carinatum may feel short of breath (especially during exercise), have a fast heartbeat, feel tired, or have chest pain. Some can develop asthma and frequent respiratory infections.
Pectus carinatum can affect one side of the chest more than the other. Sometimes, kids have pectus carinatum on one side of the chest, and a different chest wall disorder — pectus excavatum, which causes the chest to look sunken — on the other side.
The condition gets worse as kids grow, and affects boys more often than girls.
How Is Pectus Carinatum Diagnosed?
Health care providers diagnose pectus excavatum based on a physical exam and a child's medical history. If needed, they might also order tests such as:
- chest X-ray to see the severity of the condition
- imaging scans like computed tomography (CT) or magnetic resonance imaging (MRI)
- electrocardiogram to test heart function
- pulmonary function tests to check the lungs
- genetic testing to look for related syndromes
How Is Pectus Carinatum Treated?
Kids and teens with mild pectus carinatum — who aren't bothered by their appearance and don't have breathing problems — don't need treatment.
Kids whose bones are still growing can wear a chest brace. Similar to how braces realign teeth, a chest brace will push the breastbone back to a normal position. Kids need to wear a brace for 6 months to a year. They can remove it for sports, showering, and other activities, but usually must wear it for 8 hours a day or longer.
In some cases, surgery can treat pectus carinatum. In the Ravitch procedure, a surgeon removes damaged cartilage, repairs or reshapes the sternum, and places a bar (or bars) in the chest wall to hold it in the proper position. The bar will be removed in a later surgery, usually after about 6 months. This surgery is typically used for patients 13 to 22 years old.
Doctors also might recommend physical therapy and exercises to strengthen weak chest muscles.
Mild pectus carinatum won't need treatment if doesn't affect how the lungs or heart work. But when the condition is very noticeable or causes health problems, a person's self-image can suffer. In those cases, treatment can improve a child's physical and emotional well-being.
Most kids and teens who wear a brace or undergo surgery do very well and are happy with the results.
Reviewed by: Cynthia Reyes-Ferral, MD
Date reviewed: December 07, 2017