Here, I answer the most frequently asked questions by my adult patients and parents of children who have been diagnosed with pectus excavatum.
As a diagnosed radiographer I have x-rayed a few patients with pectus excavatum and to my own interest I was keen to do an extensive reading of medical scientific publications to educate myself and try to answer the many questions I always hear from my patients.
Happy reading!😀
Any questions? remarks? Let’s meet in the comments section at the end of this article.🙏
Last updated: Sept 2024. Written by Juliet Semakula, a diagnostic radiographer.
Disclaimer: no affiliate links.
▶️Is pectus serious?
Pectus excavatum is a relatively common chest deformity that manifests very differently from person to person.
Pectus excavatum also known as a (funnel chest) is an abnormal condition where the breastbone or the sternum is sunken into the chest.
The extent of the deformity varies:
🟠Mild symmetrical Pectus excavatum with a cup shaped deformity and minimal rib flaring.
🟠Moderate symmetrical pectus excavatum with more of a saucer shaped deformity and minimal rib flaring.
🟠Moderate symmetrical pectus excavatum with more of a cup shaped discrete deformity and moderate rib flaring.
In other words, having a significant deformity does not mean you will necessarily have more physical or psychological problems related to pectus excavatum.
According to studies, up to 10 to 15 years old require only exercises and rehabilitation therapy if the deformity is painful (Doucha,2023)
At 16 years and above, you may be offered a surgical solution if the deformity is painful, affects the function of the lungs, heart or results in psychological problems.
If the deformity progresses too much, complications can occur in some people. Or complications can arise from surgery sometimes.
In summary pectus excavatum is a relatively common deformity more in male than females with minimal consequences for most people.
▶️What does pectus excavatum look like and what is a clinical presentation?
Pectus excavatum is when the ribs and sternum (breastbone) grow inward and form a dent in the chest. This gives it a concave or caved-in shape, which is why the condition is also called “funnel chest” or “sunken chest.” It can be mild or severe.
Image showing Pectus excavatum were an inward deformation of the sternum or anterior chest wall.
▶️What are the symptoms or clinical presentations of pectus excavatum.
Pectus excavatum is often diagnosed in early childhood and usually does not cause symptoms until after puberty or in adulthood.
1️⃣Chest pain caused by mitral valve prolapse (Barlow syndrome).
When you have a normal functioning mitral valve, this allows unimpeded blood flow into the left ventricle during diastole and should prevent backflow of blood into the left atrium during systole.
But when you have pectus excavatum, the mitral valve is affected in the way blood flows into the ventricle and some people may experience atypical chest pain and palpitations.
2️⃣Shortness of breath and wheezing upon exertion or exercises.
3️⃣A Lateral curvature of the spine and absence of the curve of the upper back
4️⃣Hooked shoulders
5️⃣A broad or thin chest
6️⃣Weakness or early fatigue compared to aged-matched peers.
7️⃣Gastroesophageal reflux may occasionally occur.
8️⃣Tachycardia.
9️⃣Fainting/dizziness.
These symptoms often vary in severity and their effect on an individual daily activities.
The severity of the defect does not necessarily correlate with the severity of symptoms.
Many patients are asymptomatic at a younger age but start experiencing symptoms as they enter their teens.
This is attributed to maybe the worsening of the defect or an increase in exercise and physical activity
The most important thing you need to know is that most people with Pectus Excavatum do not have visible symptoms to worry about in their daily lives, although many may have significant visual concerns.
▶️Why do some people have pectus excavatum and others do not.
Pectus excavatum without any identifiable cause other than likely genetic is said to be the most common cause.
Several hypotheses are proposed to explain it, but none have reached an accord conclusion (Tong X 2022):
🟢Genetic link:
The cause of pectus excavatum remains largely undefined, but the prevalence of a family history of pectus excavatum may be very high, potentially reaching up to 40% of patients with the condition.
A study done by Coulson, in 1820, reported a genetic component was identified in the occurrence of 3 affected brothers and a 17-year-old with the condition present at birth whose brother and father were also affected.
🟢Excessive growth of connective tissue from the ribs to the sternum
Pectus excavatum can be associated with scoliosis and connective tissue disorders.
The condition may not be noticeable at birth and may remain undetected until puberty, more often in males.
▶️Can you fix pectus excavatum? How is it treated?
Several factors determine the treatment approach for pectus excavatum, including the extent of deformity, age at onset, personal preferences and the health provider.
Treatment option range from:
🟡Regular clinical monitoring often by x-rays, MRI and ultrasound without any specific treatment unless it is causing you pain.
Pain is the presenting complaint in many patients with pectus excavatum.
🟡Usually, to help with pain, doctors prescribe anti-inflammatory medications.
🟡 Osteopathic manipulative treatment is a system of hands-on techniques used by osteopathic physicians to treat and improve function.
🟡Acupuncture are types of pain medication that help to stimulate the central nervous system to help promote physical and emotional wellbeing.
🟡Therapy option: if you have mild signs and symptoms, you may need physical therapy sessions to help improve posture and increase the degree to which the chest can expand.
🟡Surgery option.
Pectus excavatum can be surgically repaired, but surgery is usually reserved for people who have moderate to severe signs and symptoms.
Patients should be carefully selected based on symptoms as candidates for surgical repair (Huddleston 2004):
Poor body image and impaired psychosocial function is an enormously important concern for surgical repair
The type of repair employed depends on the surgeon’s own personal expertise as either:
Currently, most surgeons will wait for patients to reach adolescence or early teenage years to perform repair.
Repair during the later stages of teenage growth allows the patient to complete their growth and have a lower chance of recurrence.
Younger children with significant cardiopulmonary compromise may also be candidates for repair depending on the severity of their symptoms.
Types of surgery repair:
1️⃣The modified Ravitch.
Using a modified Ravitch technique where cartilage is removed to help elevate the breastbone with two stainless steel struts inserted through a small vertical incision in the mid-chest.
2️⃣Nuss procedure provides satisfactory results.
Nuss procedure, a type of video-assisted thoracic surgery generally used for adolescent patients.
A curved steel bar (known as the Lorenz Pectus Bar) is inserted through two small incisions under the sternum. It pushes out the depression and is then fixed to the ribs on either side.
Images of surgical repair :Preoperative (upper images) and postoperative (lower images on left and right)
▶️Is surgery beneficial?
The critical finding of some research studies identified:
Surgical repair improved cardiovascular function by more than 1⁄2 standard deviation (Malek 2006)
Paediatric and adult patients show subjective clinical improvement in exercise tolerance after pectus excavatum repair in most cases.
The benefits are likely multifactorial demonstrating improved respiratory mechanics and increased stroke volume due to relief of right ventricular compression.
This has been confirmed by some patient’s personal testimony after repair.
However, repair at too early of an age can result in improper growth of the chest wall and other complications, including recurrences
Surgical correction of pectus excavatum can be performed safely with minimal risk.
These findings, along with current ongoing investigations, further the argument that surgical repair is indicated for symptomatic patients regardless of physiologic testing and is more than primarily cosmetic.
Surgical repair can significantly improve the difficulties with body image and limitations on physical activity.
I think the importance of these concerns to the child and family should not be underestimated by physicians.
Most parents fear the cost of treatment, am not sure about other countries but
Here in the United Kingdom the NHS England will fund treatment for the most severe cases of pectus deformity, but only after a multi-disciplinary process of assessment.
▶️What happens if pectus excavatum is left untreated?
It is crucial that if you believe you have Pectus Excavatum, you seek medical advice.
If left untreated, severe cases of pectus excavatum can lead to compression of the heart and lungs or push the heart over to one side.
Even mild cases of pectus excavatum can result in self-image problems.
Nowadays, it is possible to correct it easily at almost any age and with very little pain.
And remember, you are not alone; there are great experts in the treatment of thoracic malformations and completely safe treatment options as discussed above.
▶️ Can you live a full life with pectus excavatum?
YES, you can live a full life. There’s no evidence that pectus excavatum directly affects life expectancy.
At what age does pectus excavatum get worse?
Once you reach adulthood, toward the end of adolescence, the progression of Pectus Excavatum usually stabilises.
Does this mean that at this age, the sunken chest stops getting worse? Indeed, it means that since your body is fully developed, the depth or deformity of your sunken chest will not worsen.
However, Pectus Excavatum can also lead to other physical diagnoses that can worsen your health, such as:
Emotional disturbances and self-esteem issues due to your aesthetic impairment.
All of these can significantly affect your quality of life.
In some people, the depth of the indentation worsens in early adolescence and can continue to worsen into adulthood.
In severe cases of pectus excavatum, the breastbone may compress the lungs and heart.
▶️What is the life expectancy of someone with pectus excavatum?
No, most people with pectus excavatum do not have their life expectancy reduced because of the condition.
However, if a severe sunken chest goes untreated, it can lead to dangerous heart and lung symptoms.
This can put pressure on the lungs and heart so they don’t have enough room to work as they should. The ribs may stick out on one side of the chest
There’s no evidence that pectus excavatum limits life expectancy or causes progressive damage to your heart and lungs over time.
But without surgery, your symptoms may get worse. This could lead to a shorter life expectancy than the general population.
▶️Is it OK to exercise with pectus excavatum?
As exercise can be difficult for people with pectus excavatum, it might sound surprising to hear it can be used to improve the condition, but it will not cure PE.
Exercise can provide the following benefits:
🟣 Developing the upper body area
🟣Expanding the lungs capacity
🟣 Improving posture
🟣Adding muscle mass to the pectorals and spine muscles
Caution! Strengthening and stretching the core muscles can help with rib flare caused by pectus excavatum in some individuals.
Pectus excavatum symptoms may include shortness of breath and lower stamina during exercise, fatigue, chest pain, and a fast heartbeat.
Because of these problems with fatigue and stamina, it is best to start exercising slowly and gradually increase your activity.
If you feel you are losing it in the process you can stop and rest.
We have come to the end of this article; hope you have learnt something from this. Wishing you a quick recovery!🙋
Questions and comments are welcome.
📚Source:
Huddleston CB. Pectus excavatum. Semin Thorac Cardiovasc Surg. 2004 Fall;16(3):225-32. doi: 10.1053/j.semtcvs.2004.08.003. PMID: 15619190.
Sujka JA, St Peter SD. Quantification of pectus excavatum: Anatomic indices. Semin Pediatr Surg. 2018 Jun;27(3):122-126. doi: 10.1053/j.sempedsurg.2018.05.006. Epub 2018 May 16. PMID: 30078482.
Notrica DM, McMahon LE, Jaroszewski DE. Pectus Disorders: Excavatum, Carinatum and Arcuatum. Adv Pediatr. 2024 Aug;71(1):181-194. doi: 10.1016/j.yapd.2024.05.001. PMID: 38944483.
Jaroszewski, D.; Notrica, D.; McMahon, L.; Steidley, D.E.; Deschamps, C. Current management of pectus excavatum: A review and update of therapy and treatment recommendations. J. Am. Board Fam. Med. 2010, 23, 230–239. [CrossRef] [PubMed]
Denzinger, M.; Reis Wolfertstetter, P.; Sossau, D.; Hümmer, H.P.; Knorr, C. Minimalized Erlangen Correction Method by Hümmer (MEK) Compared with Conventional and Minimally Invasive Correction Methods for Pectus Excavatum Single Center Experience. Appl. Sci. 2023, 13, 10009. https://doi.org/10.3390/app131810009
Obermeyer RJ, Cohen NS, Jaroszewski DE. The physiologic impact of pectus excavatum repair. Semin Pediatr Surg. 2018 Jun;27(3):127-132. doi: 10.1053/j.sempedsurg.2018.05.005. PMID: 30078483.
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Malek MH, Fonkalsrud EW, Cooper CB. Ventilatory and cardiovascular responses to exercise in patients with pectus excavatum. Chest 2003;124:870 – 82
Malek MH, Berger DE, Marelich WD, Coburn JW, Beck TW, Housh TJ. Pulmonary function following surgical repair of pectus excavatum: a meta-analysis. Eur J Cardiothorac Surg 2006;30:637– 43.
Park JM, Varma SK, Pectus excavatum in children: diagnostic significance for mitral valve prolapse. Indian J Pediatr 1990;57:219 –22.
Tong X, Li G, Feng Y. TINAG mutation as a genetic cause of pectus excavatum. Med Hypotheses. 2020 Apr;137:109557. doi: 10.1016/j.mehy.2020.109557. Epub 2020 Jan 8. PMID: 31981812.Doucha M, Kučerová B, Newland N, Vyhnánek M, Rygl M, Koucky V, Pohunek P, Šnajdauf J. Treatment of the congenital thoracic deformity pectus excavatum. Rozhl Chir. 2023;102(9):352-355. English. doi: 10.33699/PIS.2023.102.9.352-355. PMID: 38286663.