Overview

What Is a Chest Wall Deformity?

What Is a Chest Wall Deformity?

There are two basic types of chest wall deformities:

    1. pigeon breast (pectus carinatum), where the breastbone is pushed outward, and
    2. funnel chest (pectus excavatum), which is when the breastbone curves inward.

Chest wall deformities can also include Poland syndrome, which is the absence or underdevelopment of the chest muscle on one side of the body.

The causes of chest wall deformities are mostly unknown, but could be linked to genetic history because there are enough cases to suggest genes could contribute.

Our pediatric surgery team includes specialists who perform chest wall reconstructions to correct these conditions.

Pectus Carinatum (Pigeon Breast)

Usually, when a child has pigeon breast, the symptom is the appearance of the chest rather than any problems with the function of organs in the chest (although extreme cases can affect the heart and lungs making a child have shortness of breath and fatigue). The sternum and ribs stick further out of the chest than normal, which is caused by an overgrowth of cartilage.

This condition can be seen in newborns as a rounded chest; when they reach two or three years old, their breastbone or sternum begins to grow outwardly. Most commonly, however, pigeon breast occurs in 11–14 year olds when going through a growth spurt. The exact causes of the condition are not known; although, it is more common in children with connective tissues syndrome (such as Marfan syndrome) and congenital heart disease. Genetics do play a small role in some cases. It is also far more common in boys than girls and can cause scoliosis or curvature of the spine.

Treatment

Treatment for pigeon breast can include bracing or the Ravitch procedure. A specialist might recommend a customized chest-wall brace, which must be worn regularly as advised by your specialist.

Another option is surgical. A surgical procedure your specialist might use is the Ravitch technique. The Ravitch technique cuts away the abnormal rib cartilage and flattens the sternum. Bars or struts also may be inserted to help the sternum maintain the new shape.

Your specialist will help you learn about each of the treatment options available to you and advise you on what is best for your child’s condition.

PECTUS EXCAVATUM (FUNNEL CHEST)

Funnel chest refers to a chest abnormality where the chest looks sunken or caved in. It is generally present at birth or visible soon after. It can also be progressive and increase as the child grows. Like pigeon breast, the causes of funnel chest are not entirely known, but may include syndromes like Marfan syndrome (a connective tissue syndrome) or genetic causes. Again, boys are far more likely to have funnel chest than girls.

Children with funnel chest may experience pain in that area, especially after vigorous exercise. Because the heart can be displaced by the sternum, the child might have palpitations or mitral valve prolapse. Sometimes lung capacity is reduced as well and the child might have asthma.

Treatment

Specialists may suggest one of two different procedures, the Nuss procedure or the Ravitch procedure. The Ravitch procedure cuts away abnormal rib cartilage and repositions the sternum, leaving a bar in the chest.

In the Nuss procedure, the incision is made on the side of the chest and does not involve removing the excess cartilage. The Nuss procedure is also less invasive than the Ravitch procedure.

Poland Syndrome

Poland syndrome is a disorder where the muscles of the chest wall are underdeveloped or absent. Sometimes, on the side of the chest where the muscles are affected, the patient’s hand may have webbing between the fingers (syndactyly) as well. Poland syndrome appears more frequently in males than females, and the causes are unknown (and not genetically related).

Treatment

Surgical treatment for patients with Poland syndrome can be done to create a more symmetrical look to the chest. Your specialist will discuss the best technique with you and your child to treat this syndrome.

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