Chest Wall Malformations

Chest Wall Disorder: Pectus Excavatum

What Is Pectus Excavatum?

Pectus excavatum is a genetic deformity of the chest wall that causes several ribs and the breastbone (sternum) to grow abnormally.

Usually, the ribs and sternum go outward at the front of the chest. With pectus excavatum, the sternum goes inward to form a depression in the chest. This gives the chest a concave (caved-in) appearance, which is why the condition is also called funnel chest or sunken chest.

What Causes Pectus Excavatum?

Doctors don't know exactly what causes pectus excavatum (PEK-tus eks-kuh-VAY-tum). In some cases, it runs in families.

Kids who have it often have another health condition, such as:

  • Marfan syndrome — a disorder that affects the body's connective tissue
  • Poland syndrome — a rare birth defect marked by missing or underdeveloped muscles on one side of the body, especially noticeable in the major chest muscle
  • rickets — a disorder caused by a lack of vitamin D, calcium, or phosphate that leads to softening and weakening of the bones
  • scoliosis — a disorder in which the spine curves incorrectly

What Are the Signs & Symptoms of Pectus Excavatum?

A sunken chest is the chief sign of pectus excavatum. The condition may not be apparent for the first few years or sometimes even until the teenage years, even though it's present at birth.

Mild cases might be barely noticeable. But severe pectus excavatum can cause a deep hollow in the chest that can put pressure on the lungs and heart, causing:

  • problems with exercise or lots of physical activity
  • tiredness
  • chest pain
  • a rapid heartbeat or heart palpitations
  • frequent respiratory infections
  • coughing or wheezing

The condition gets worse as kids grow, and affects boys more often than girls.

How Is Pectus Excavatum 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:

How Is Pectus Excavatum Treated?

Kids with mild pectus excavatum — who aren't bothered by their appearance and don't have breathing problems — don't need treatment.

In some cases, surgery can treat pectus excavatum. 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.

A more recent technique, the Nuss procedure, is less invasive. The surgeon inserts a curved metal bar through a small incision to push out the chest. A stabilizer bar is added to keep it in place. The chest is permanently reshaped in 2–4 years and both bars are surgically removed. The Nuss procedure can be used with patients age 9 and older.

Doctors also might recommend physical therapy and exercises to strengthen weak chest muscles.

Looking Ahead

Mild pectus excavatum won't need treatment if it 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