Chest Wall Malformations

Nemours pediatric surgeons have significant experience diagnosing, treating and caring for children and teens with chest wall malformations. This includes conditions such as pectus excavatum ("sunken chest" or "funnel chest") and pectus carinatum ("protruding chest" or "pigeon chest"). Your child may only have a minor chest wall anomaly that causes little or no health concerns. However, if the condition is severe, it can cause medical problems, so you should see a specialist early on to make sure your child gets the proper care. 

There are many options when it comes to treating chest wall malformations. Bracing or surgery can often help with medical issues as well as positively affect your child's appearance and self-esteem. The key is to get an evaluation as early as possible. This allows your family to better:

  • understand your child’s condition and its current and potential cardiovascular (heart and lung) impact, if any
  • prepare for potential physical and social impacts
  • learn which surgical procedures and treatment options are available to manage your child’s condition
  • ensure that your child is treated at the ideal time during their skeletal development (it varies from child to child)
  • explore nonsurgical management options
 
Types of Chest Wall Malformations

Pectus Excavatum (PE)

Pectus excavatum (PE) is a malformation that causes several ribs and the breastbone (sternum) to grow in an unusual way, giving your child’s chest a concave, or caved-in, appearance. The condition is also called funnel chest or sunken chest, although we encourage you to refer to it as PE. 

PE is congenital (present at birth), but often it does not become apparent until your child grows, particularly once they become a teen. Mild cases might be barely noticeable, but severe cases can affect your child’s heart and lungs.  

Causes of Pectus Excavatum

Pectus excavatum can occur on its own and is not connected to any genetic defect, although 35 percent of the time there is a family history of the condition. It can also be associated with other syndromes, including:

  • Marfan syndrome — a disorder that affects the body's connective tissue
  • Poland syndrome — a rare birth defect characterized 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, which leads to softening and weakening of the bones
  • Scoliosis — a disorder in which the spine curves incorrectly (noted in about 30 percent of pectus patients)

Pectus Carinatum (PC)  

Pectus carinatum (PC) is a condition in which the chest protrudes outward. The breastbone juts out, leaving a narrow depression along the sides of the chest. This gives the chest a bowed-out appearance. It may also be called pigeon chest or protruding chest, although we encourage you to refer to the condition as PC.

Children and teens with PC generally develop normal hearts and lungs, but there can be some impacts. For example, some children and teenagers report breathing and significant psychological problems.

Causes of Pectus Carinatum

The condition can occur on its own, or it can be associated with other genetic disorders or syndromes such as:

  • Down syndrome — also known as trisomy 21, a genetic disorder caused by the presence of all or part of an extra copy of chromosome 21
  • Edwards syndrome —  also known as trisomy 18, a genetic disorder caused by the presence of all or part of an extra  chromosome 18
  • homocystinuria — a disorder that involves the incorrect metabolism (the physical and chemical processes the body uses to convert or use energy) of a specific amino acid that the body uses to make protein and build tissues
  • Marfan syndrome — a disorder that affects the body's connective tissue
  • Morquio syndrome — an abnormality in the growth, development, shape or integrity of the bones and cartilage, most commonly resulting in dwarfism
  • osteogenesis imperfecta — a condition that causes the bones to be excessively fragile (also known as brittle bone disease)
 
Treatment for Chest Wall Malformations

Based on the severity of the malformation, treatment can include surgery or a nonsurgical approach such as bracing, vacuum bell treatment, or observation and monitoring. We’re here to educate you on these options as well as offer guidance and answer questions so you can make the best decision for your child. 

Surgery Options

Ravitch procedure (PE or PC): During, the Ravitch procedure, a surgeon makes an incision then removes abnormal cartilage and repairs or reshapes the sternum and ribs. This procedure can be used to correct either PE or PC and is typically performed when a child is between 13 and 20 years of age.

Nuss technique (PE only): The Nuss technique is a minimally invasive procedure used to repair PE. During this procedure, a surgeon makes small incisions then inserts a bar into the chest to push it forward — like an internal brace.  The chest is reshaped and the bar is removed after three years. This procedure can be performed on children 8 years of age and older.

Nonsurgical Options

Vacuum bell (PE only): This procedure uses a suction cup that creates a vacuum seal on the anterior (front) chest wall. This lifts the sternum and, over time, can correct PE.  This option is more effective in young children. 

Nemours Physical Therapy Services

Your doctor may also recommend physical therapy and exercises to help strengthen your child’s weak chest muscles. Nemours has extensive physical medicine and rehabilitation services available on-site that are staffed by highly experienced experts trained to work with children who have chest wall malformations.

Nemours/Alfred I. duPont Hospital for Children, Wilmington


1600 Rockland Road
Wilmington, DE 19803
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For Appointments: (302) 651-4200

 
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Additonal Chest Wall Center Team Members
  • Jaszczyszyn, Danielle, CPNP
 
What to Bring
  • photo ID
  • medical and pharmacy insurance cards
  • preferred pharmacy name and phone number
  • names and dosage of all medications, including over-the-counter medication, your child is currently taking
  • guardianship and custody papers, if a legal guardian rather than a parent accompanies your child
Returning Patients
  • Patient Presents Without Legal Guardian (PDF)
    English | Spanish
    Note: A parent or legal guardian must be with a child for a first visit.
 
Forms & Resources
Returning Patients
  • Patient Presents Without Legal Guardian (PDF)
    English | Spanish
    Note: A parent or legal guardian must be with a child for a first visit.
Resources for Patients & Families

At Nemours/Alfred I. duPont Hospital for Children, our pediatric general surgeons offer expert care to families from all over the region, especially Delaware, Pennsylvania, New Jersey and Maryland. Here, our pediatric general surgeons perform minimally invasive repair of pectus excavatum — including the Nuss procedure — for children with pectus excavatum (PE). We also offer treatment for other types of chest wall anomalies as well.