 Chest Wall Deformities
|
 |
|
|
|
|
| This Health Topic is not associated with any programs or procedures. |
|
|
|
|
|
|
|
|
|
|
Chest wall deformities are fairly common structural deformities in the chest. They are generally divided into two types:
|
|
|
|
|
|
Funnel chest is a depression or hollow caused when the breastbone, the bone in the middle of the ribcage, is pushed abnormally inward. It is either congenital (present at birth) or it develops within months of birth. Mild cases, on occasion, correct themselves, usually by 3 years of age. In moderate and severe cases however, funnel chest may grow progressively worse and require surgery. Other children with what appears to be funnel chests do not require treatment. For example, it is common for infants with breathing difficulties to have intermittent drawing in (retractions) of their chests. In addition, some infants and children have mild to moderate hollows in the center of their chests during inhalation and appear normal during exhalation.
True funnel chest exists when the chest remains sunken even when a child exhales or is resting. When a child with funnel chest is examined either sitting or lying on the back, face up, the hollow in the chest is unchanged or rigid. For those children who undergo surgery, normal breathing returns. In fact, the outlook is excellent for 90 to 95 percent of those who are treated for this problem; for about 1 in 30 children, a second operation may be required.
|
|
|
|
|
|
Pigeon Breast is caused when the breastbone is pushed outward. Girls usually develop pigeon breast at a somewhat younger age then boys, who do not develop the condition until adolescence, usually from 11 to 14 years of age. As with funnel chest, this condition may interfere with a child's physical health. The deformity often increases in severity each year until a child reaches full growth. Scoliosis is associated with this condition and becomes more controllable after treatment. Surgery can correct pigeon breast and the outlook for children who have the operation is excellent.
|
|
|
|
|
|
Approximately 1 out of every 300 children has funnel chest and pigeon breast is about one third as common as funnel chest. Three out of four cases of pigeon breast involve boys.
|
|
|
|
|
|
The cause of both chest deformities is unclear. Both conditions tend to recur in families, suggesting genetics may play a role. Excessive growth and structure abnormalities of the cartilage (tough, elastic tissue) of the ribs and breastbone are present in both conditions. If pigeon breast is present during infancy, it may be associated with premature fusion of the segments of the breastbone, a short wide breastbone, and congenital heart disease.
|
|
|
|
|
|
In infancy, symptoms of funnel chest can include:
|
|
|
- Frequent lingering colds that often develop into pneumonia
- A hollow depression in the chest that may be broad and shallow, deep and narrow, or assymetric
- Difficulty breathing
|
|
In older children, symptoms of funnel chest can include:
|
|
|
- Breathing difficulty upon exertion or exercise
- Chest pain
- Frequent respiratory infections
- Some children have a lateral curvature of the spine, absence of the curve of the upper back, hooked shoulders and a broad thin chest.
|
|
Symptoms of pigeon chest include
|
|
|
- Difficulties playing and exercising
- Tenderness and intermittent pain in the area of overgrown cartilage
|
|
The symptoms of chest wall deformities may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis
|
|
|
|
|
|
Your child's doctor can diagnose a chest wall deformity after observing a child after he or she inhales, exhales and rests. The physician also calculates the depth of the chest from front to back using X-ray films of the chest to determine whether the diameter is shorter than average (funnel chest) or longer than average (pigeon breast). The heart is usually widened and displaced to the left. Lung capacity can be measured by exercise tests and lung scans, which often reveal mismatched lungs. Other tests your child may encounter include:
|
|
|
- Electrocardiogram (ECG or EKG) - a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle stress. For more information, see ECG/EKG or Exercise ECG/EKG testing.
- Echocardiogram (echo) - a procedure that evaluates the structure and function of the heart by using sound waves recorded on an electronic sensor which produce a moving picture of the heart and heart valves. For more information, see echocardiography.
|
|
|
|
Children with moderate to severe cases of funnel chest may require surgery, ideally between 5 and 10 years of age. When surgery is performed in adolescence, lung function may not improve unless additional growth is expected. Corrective surgery for funnel chest should never be performed before 2 years of age. Surgical results are superior when the surgery is performed before adolescence, and spontaneous improvement of a severe problem is unlikely. If severe cases are not corrected, deformity of bones, scoliosis, and asymmetry develop, making surgery more difficult. Both conventional open procedure or minimally invasive procedures can be used to operatively correct the deformity.
Surgery may be necessary for children with pigeon breast, which typically grows worse until late adolescence. Surgery involves removal of the involved rib cartilages and repositioning of the breastbone, essentially the mirror image of that performed for funnel chest. Surgery restores normal chest contour.
|
|
|
