Pectus Carinatum

Pectus carinatum is a deformity of the chest wall in which the breastbone and ribs are pushed outward. Pectus carinatum is sometimes called “pigeon breast” because of the birdlike appearance of the chest. The condition occurs in about 1 out of 1,000 children. Boys are more frequently affected that girls.

Pectus carinatum often gets worse as a child grows, particularly during puberty. Approximately 15 percent of children with pectus carinatum develop scoliosis.

The most obvious symptom of pectus carinatum is a chest that juts out. The condition is often asymmetric (lopsided), with one side of the chest pushed out further than the other. 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 types of pectus carinatum:

• Chondrogladiolar prominence, in which the middle and lower part of the breastbone juts forward. This type accounts for nearly 95 percent of cases of pectus carinatum. 
• Chondromanubrial prominence, also known as pectus arcuatum, is a rare type of mixed pectus in which the upper breastbone juts out and the lower breastbone is sunken in.

Other than the appearance of their chest, most children with pectus carinatum have no symptoms, but some children feel pain during physical activity.

Children with pectus carinatum have an increased risk of connective tissue disorders such as Marfan syndrome or Ehlers-Danlos syndrome.

There is no known cause for pectus carinatum. Although the majority of children with the condition don't have a family history, enough do for doctors to suspect that genes may play a significant role. Researchers are therefore looking into a possible genetic component.

Pectus carinatum can usually be diagnosed during a physical examination. Your child’s doctor may recommend additional tests to detect other related conditions.

At Boston Children’s Hospital, we also use a white light scanner — a type of three-dimensional (3D) camera — to help measure your child’s chest wall depression and monitor their response to treatment over time.

Other recommended tests might include:

• An X-ray to help determine if your child has scoliosis or any other abnormalities of the bones
• An echocardiogram (echo) to help determine if your child’s heart is affected by the shape of their chest wall

Your child may not need treatment if they have a mild case of pectus carinatum. If your child’s condition is moderate or causes physical or social problems, their doctor may recommend bracing. If bracing is not effective, or if your child has a severe chest wall deformity, they may need surgery.

How does bracing work?

Bracing can treat mild to moderate pectus carinatum in young children whose chests are still flexible. Once the chest bones are completely formed during adolescence, bracing becomes much less effective.

A brace will be made specifically for your child based on their measurements and the shape of their chest. By applying pressure to the protruding breastbone and cartilage, the brace will gradually reshape the chest wall. The brace may need to be adjusted from time to time as your child grows.

Your child will need to wear the brace at home and when sleeping at night. The process of correction will often take about one to two years, depending on how fast and how much your child grows. The length and effectiveness of the treatment will depend on your child wearing the brace consistently.

How is pectus carinatum corrected with surgery?

In the unlikely case that your child needs surgery, their surgeon will perform an operation known as the Ravitch procedure. During this procedure, the surgeon makes an incision in the chest wall, removes cartilage wedged between the ribs and sternum, then reshapes and repositions the sternum.

The Pectus and Chest Wall Treatment Program at Boston Children’s Hospital evaluates and treats infants, children, and young adults using state-of-the-art methods to improve the quality of life for each child entrusted to our care.

We base our treatment of pectus carinatum and other chest wall deformities on the severity of the condition. For mild cases, we typically recommend close observation without treatment unless the condition becomes more pronounced. If your child’s condition is more severe, we may treat them with a customized brace that gradually reshapes the chest.

When our patients need surgery, we use advanced technologies to ensure their safety and comfort. This includes cryoablation to manage post-surgical pain and improve recovery time.

If your child develops scoliosis, we work closely with our colleagues in Boston Children’s Spine Division, one of the nation’s foremost pediatric treatment and research centers. When a patient has a connective tissue disorder such as Marfan syndrome or Ehlers-Danlos syndrome, we refer them to the Center for Cardiovascular Genetics for additional diagnostic testing.