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Pectus Carinatum

  • Pectus carinatum is primarily a cosmetic concern. Mild cases may not need any treatment at all, while moderate-to-severe cases can be treated effectively by bracing or surgery". -Jay M. Wilson, MD, senior associate in Boston Children's Hospital's Department of Surgery

    Jay M. Wilson, MD, senior associate in Boston Children's Hospital's Department of Surgery

    Here are some of the basics about pectus carinatum, also known as "pigeon breast": 

    • It is a deformity of your child's chest wall where the breastbone is pushed outward. 
       
    • It occurs in approximately 1 out of 1,500 children.
       
    • It’s not a life-threatening condition and treatment is typically straightforward, so your child should grow up to lead a normal, active life.
       
    • It occurs more frequently in boys than girls.
       
    • It is usually not noted until after the 11th birthday.
       
    • A mild deformity noted at birth or in early childhood often worsens as the child grows, particularly when the child reaches puberty.
       
    • Approximately 15 percent of children with pectus carinatum end up developing curvature of the spine (scoliosis).
       
    • There haven’t been any reports of children with pectus carinatum having heart or breathing problems related to the condition.
    Pectus carinatum

    How Boston Children’s Hospital approaches pectus carinatum

    For mild cases of pectus carinatum, there’s really no reason to do anything to try to fix it.

    If your child’s condition is a bit more severe, we often treat him with a customized brace that gradually reshapes the chest. In rare cases, your child’s doctor may recommend surgery. Boston Children’s General Surgery Program evaluates and treats infants, children and young adults using state-of-the-art operative methods to improve the quality of life for each child entrusted to our care.

    Boston Children's Hospital 
    300 Longwood Ave
    Boston MA 02115

     617-355-7800
  • In-Depth

    What is pectus carinatum?

    Pectus carinatum is a deformity of your child's chest wall in which it is pushed outward. It’s often asymmetrical, with one side of the chest affected more than the other. In addition, some children have pectus carinatum on one side of the chest and an indentation called pectus excavatum on the other side of the chest. 

    There are two basic types of pectus carinatum: 

    • Chondrogladiolar prominence (also known as “chicken breast”) — nearly 95 percent of people who have pectus carinatum have this type.
       
    • Chondromanubrial prominence (also known as “Pouter pigeon breast”) — this rare type of pectus carinatum can be more complex to treat.


    Causes 

    What causes pectus carinatum?

    The exact cause of pectus carinatum is not known. There is abnormal growth of the bones and cartilage, but we don’t know why. It runs in families; in up to 25 percent of cases, there is someone else in the family who has it.

    Signs and symptoms

    What are the symptoms of pectus carinatum?

    While many children with the condition don’t experience any symptoms beyond a concern about their appearance, some children have the following symptoms: 

    • Difficulty breathing during exercise or other activities
    • Frequent respiratory infections
    • Asthma

    When does pectus carinatum become apparent?

    It can sometimes be seen in newborns and during early childhood. Most of the time, though, it doesn’t become apparent until your child is 11 or 12. It’s rare for the condition to show up after that.

    Are there any medical complications associated with pectus carinatum?

    It is often associated with other abnormalities of the muscles or skeleton, the most common being curvature of the spine, or scoliosis. It’s also associated with a number of rare musculoskeletal syndromes. 

    In rare cases, if pectus carinatum 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.

    How serious is pectus carinatum?

    The level of severity goes from almost unnoticeable to severe, but the condition does tend to get worse during growth spurts. 

    What is the long-term outlook for my child?

    Pectus carinatum is primarily a cosmetic concern. Mild cases may not need any treatment at all, while moderate-to-severe cases can be treated effectively by bracing or surgery. Either way, children with pectus carinatum almost always go on to lead completely normal lives.

  • Tests

    How is pectus carinatum diagnosed?

    Your child's doctor can diagnose pectus carinatum by examining your child.

    • The physician calculates the depth of the chest from front to back using X-rays of the chest to determine if the diameter is longer than average (if it is, that means your child has pectus carinatum).
       
    • X-rays also help the doctor determine the presence of scoliosis or any other abnormalities of the bones. 

    Other tests your child's doctor might recommend include: 

    • Electrocardiogram (ECG or EKG)—a test that records the electrical activity of your child's heart, shows abnormal rhythms and detects heart muscle stress
    • Echocardiogram (echo)—a test that evaluates the structure and function of your child's heart by using sound waves recorded on an electronic sensor, which produce a moving picture of the heart and heart valves
    • Computed tomography (CT) scan—a test that is used to establish the level of severity of the condition and also help the surgical team plan for the procedure 

    After we complete all necessary tests, Boston Children’s experts will meet to review and discuss what they have learned. Then we will meet with you and your family to discuss the results and outline the best treatment options for your child.

  • At Boston Children's Hospital, our physicians are focused on family-centered care. From your first visit, you'll work with a team of professionals to create a care plan that's best for your child. 

    How is pectus carinatum treated?

    Bracing can treat mild-to-moderate cases of the condition successfully if your child's chest is still flexible. Once the chest bones are completely formed, bracing becomes much less effective. In this case — or if your child cannot or does not want to follow the rigorous bracing schedule — your doctor may recommend a surgical procedure to correct his pectus carinatum. 

    What should we expect with the bracing treatment?

    If your child's condition warrant bracing, he will see a specialist in the Boston Children's Brace Shop who will construct the brace. 

    Pectus carinatum with brace

    The brace applies pressure to the protruding breastbone and cartilage. This gradually reshaped the chest wall.

    • A brace is made specifically for your child based on your child's measurements and the shape of the protrusion. It may need to be adjusted periodically as your child grows. 

    Your child will need to wear the brace when he is at home and when sleeping at night. The process of correction will often take about a year. It's important to remember that how quickly the process occurs is directly related to how long and how consistently your child wears the brace.The most important factor in the successful treatment of pectus carinatum is your child's desire to get rid of the protrusion and improve the appearance of his chest. 

    What happens if our doctor recommends surgery or the bracing fails to correct his condition?

    Pectus carinatum can be surgically repaired in an operation called the Ravitch. In this procedure, the surgeon makes an incision in your child's chest wall, removes the cartilage wedged between the ribs and sternum, then reshapes and repositions the freed-up sternum.

    A bar is left in the chest wall to maintain the correct shape for six months, during which time your child has to refrain from activities that might involve a collision, like football.

    Coping and support 

    There are a lot of resources available to assist you and your child with the diagnosis of pectus carinatum—within Boston Children's, in the outside community and online. 

    Patient education: From the very first visit, our staff will be on hand to walk you through your child's treatment and help answer any questions you may have. They'll also reach out to you by phone, continuing the care and support you received while at Boston Children's. 

    Parent to parent: Want to talk with someone else whose child has been through the bracing procedure or surgery? We can put you in touch with other families who can share their stories. 

    Social work and mental health professionals: Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis and dealing with financial difficulties. 

    On our For Patients and Families site, you can read all you need to know about: 

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