Understanding Pectus Excavatum and Its Effects on the Chest

Written by Medicover Team and Medically Reviewed by Dr Ravi Kumar Siripurapu , Ctvs Cardiothoracic And Vascular Surgery

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Pectus excavatum, often referred to as "funnel chest," is a structural deformity characterized by a sunken appearance of the chest. This condition can range from mild to severe and may affect breathing, exercise tolerance, or self-esteem in some individuals.

Pectus excavatum usually develops during childhood or adolescence and may become more noticeable as the chest grows. Evaluation helps determine the severity of the deformity and whether treatment is needed.

What are the Symptoms of Pectus Excavatum?

The severity of pectus excavatum varies, and some people have no symptoms other than the visible chest depression. Others may develop physical symptoms, particularly when the deformity is more pronounced.

Physical Symptoms

Sunken chest appearance: Visible depression in the center of the chest
Chest pain: Discomfort or pain, especially during physical activity
Shortness of breath: Difficulty breathing during exertion
Fatigue: Reduced energy levels and endurance
Reduced exercise tolerance: Limited ability to perform physical activities
Heart palpitations: May occur in some individuals, although they are not specific to pectus excavatum

Psychological Impact

The visible chest deformity can affect self-esteem and body image, particularly in adolescents and young adults. Some individuals may experience anxiety, reduced confidence, or social withdrawal because of concerns about their appearance.

Anxiety or emotional distress
Body image concerns
Social withdrawal or reduced confidence

What are the Causes of Pectus Excavatum?

The exact cause of pectus excavatum is not fully understood. It is thought to result from abnormal development or growth of the cartilage connecting the ribs to the sternum, with genetic and developmental factors potentially contributing.

The condition may occur on its own or alongside certain connective tissue disorders. Several factors have been associated with an increased likelihood of developing pectus excavatum.

Genetic Factors

Pectus excavatum can run in families, suggesting a genetic component. However, no single gene has been identified as the cause in most cases.

Connective Tissue Disorders

Pectus excavatum is sometimes associated with connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome, which can affect the development and strength of connective tissues.

Abnormal Cartilage Growth

Uneven or excessive growth of the costal cartilage may push the sternum inward and contribute to the characteristic sunken appearance of the chest.

Developmental Factors

Abnormalities in chest wall development during childhood and adolescence may influence the severity and progression of pectus excavatum.

When to See a Doctor for Pectus Excavatum?

Consult a cardiothoracic and vascular surgeon if you notice a sunken chest or develop symptoms that may be associated with the chest wall deformity. Evaluation can help determine the severity and whether further testing or treatment is appropriate.

Noticeable or progressively worsening sunken appearance of the chest
Shortness of breath or reduced exercise tolerance
Chest pain, persistent fatigue, or difficulty keeping up with physical activities

Get medical help immediately if:

Severe breathing difficulty or chest tightness
Rapid heartbeat accompanied by chest pain, dizziness, or fainting
Sudden or severe symptoms that significantly interfere with normal activities

These symptoms may indicate a serious cardiopulmonary problem and require prompt medical evaluation.

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How Is Pectus Excavatum Diagnosed?

Diagnosis of pectus excavatum involves a physical examination and, when necessary, imaging and functional tests. These assessments help determine the depth and pattern of the chest depression and whether it affects heart or lung function.

Physical examination: Assessment of chest shape, depth of indentation, and symmetry
Chest X-ray or CT scan: Imaging used to evaluate the chest wall and, when appropriate, calculate the Haller index to assess severity
Pulmonary function tests: Measure lung capacity and assess breathing efficiency
Echocardiogram: Evaluates heart function and detects possible compression or displacement
Exercise testing: Assesses the impact of the deformity on physical performance and exercise tolerance

These diagnostic tools help doctors assess the severity of pectus excavatum and determine whether observation, supportive care, or corrective treatment may be appropriate.

What are the Treatment Options for Pectus Excavatum?

Treatment for pectus excavatum depends on the severity of the deformity, the presence of symptoms, age, and its effect on heart and lung function. Mild cases without significant symptoms may only require monitoring, while more pronounced deformities may benefit from nonsurgical or surgical treatment.

Non-Surgical Treatments

Physiotherapy

Physiotherapy can help improve posture, breathing mechanics, and chest and core muscle strength. Exercises may be useful for improving functional symptoms and physical appearance, although they do not correct a significant structural depression.

Vacuum Bell Therapy

Vacuum bell therapy uses a suction device to gradually lift the sternum. It may be considered for selected children and adolescents with mild to moderate pectus excavatum, under specialist supervision.

Surgical Treatments

Nuss Procedure

The Nuss procedure is a minimally invasive surgery in which a curved metal bar is placed beneath the sternum through small chest incisions. The bar reshapes the chest wall over time and is generally removed after several years.

Ravitch Procedure

The Ravitch procedure is an open surgical technique that involves reshaping the chest wall, including removal or modification of abnormal cartilage and repositioning of the sternum. It may be considered for selected patients, including those with complex or asymmetric deformities.

Post-Surgical Care

Post-surgical care is important for proper healing and recovery. Patients may need activity restrictions, pain management, breathing exercises, and follow-up appointments according to their surgeon's recommendations.

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What are the Risk Factors of Pectus Excavatum?

Pectus excavatum can occur without an identifiable risk factor, but certain genetic and medical conditions may increase the likelihood of developing the deformity. Recognizing these associations can help doctors identify individuals who may benefit from further evaluation.

Family history: Having a close family member with pectus excavatum may increase the likelihood of developing the condition.
Connective tissue disorders: Conditions such as Marfan syndrome and Ehlers-Danlos syndrome are associated with chest wall deformities.
Male sex: Pectus excavatum is reported more frequently in males.
Adolescence: The deformity may become more noticeable during periods of rapid growth.
Associated chest wall deformities: Some individuals may have other structural abnormalities of the chest wall.

What Can Help Manage Pectus Excavatum?

There is no guaranteed way to prevent pectus excavatum because its exact cause is not fully understood. However, regular evaluation during childhood and adolescence can help identify progression and address physical or emotional concerns early.

Attend recommended follow-up appointments to monitor chest wall development.
Maintain regular physical activity according to individual ability and medical advice.
Follow physiotherapy or breathing exercises when recommended by a healthcare professional.
Seek evaluation if chest pain, breathing difficulties, or reduced exercise tolerance develops.
Discuss body image concerns or emotional distress with a healthcare professional when needed.