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What is a pectus excavatum?

Pectus excavatum, also known as concave chest or funnel chest, is a deformity of your child's chest wall. The breastbone, or sternum, and some of the ribs grow abnormally, causing a depression in the middle of the chest. The condition is not always noticeable at birth, but is often apparent by the time a child is 2 to 3. In some cases, the condition only appears as your child grows.

The level of severity ranges from mild to severe, but the condition does tend to get worse during growth spurts. While many children with pectus excavatum don’t require any treatment at all, because their condition is so mild, a more severe case can press on the heart and lungs. However, the effects on the heart and lungs are usually minor and typically only occur with extreme exercise.

Also, approximately 15 percent of children who have pectus excavatum end up developing a condition called scoliosis (curvature of the spine).

What are the symptoms of pectus excavatum?

The symptoms of pectus excavatum depend on when the condition is diagnosed. In infancy, symptoms of pectus excavatum can include:

  • a hollow depression in the chest that may be broad and shallow, deep and narrow, or irregular
  • more rapid breathing than normal

In older children, symptoms of pectus excavatum can include:

  • shortness of breath upon exertion or exercise
  • chest pain
  • a lateral curvature of the spine, absence of the curve of the upper back, hooked shoulders and a broad thin chest

What causes pectus excavatum?

There is no known cause for pectus excavatum. Some studies investigating a genetic component are underway. Although the majority of cases don't involve a family history, there are many that do — enough to warrant suspicion that genes may play a significant role.

How we care for pectus excavatum

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 operative methods to improve the quality of life for each child entrusted to our care.

Our surgeons prefer to operate on children with pectus excavatum — if they operate at all — during the child's teen years. By then, children are through most of their growth spurts and have much lower risk of recurrence.

If your child develops scoliosis, the Spine Division at Boston Children’s is one of the nation’s foremost pediatric treatment and research centers.

Pectus Excavatum | Diagnosis & Treatments

How is pectus excavatum diagnosed?

Pectus excavatum is usually diagnosed during a physical examination. X-rays of the chest can be helpful, as well.

Other tests your child's doctor might recommend include:

What are the treatment options for pectus excavatum?

If your child has a mild case of pectus excavatum, there's probably no reason for surgery. A shallow excavatum is unlikely to affect the heart or lung functioning, and your child's appearance will remain normal.

If the deformity is causing physical or social problems, it can be surgically repaired. There are two surgical options, both of which require your child to be put under general anesthesia.

Ravitch

In this procedure, the surgeon makes an incision in your child's chest wall, removes the cartilage wedged between the ribs and breastbone and repositions the freed-up breastbone. A bar is left in the chest wall to maintain the correct shape for six months. During this time, your child will have to refrain from activities that might involve a collision, like football. The technique fixes the problem but leaves a scar visible on the chest.

Nuss

In this procedure, the surgeon makes incisions on the side of your child's chest wall. The surgeon then inserts a bar laterally through the chest and moves the breastbone forward. No cartilage is removed, and scarring is less extensive.

The Nuss procedure doesn't remove any asymmetry in the way your child's chest looks. The bar has to stay in for at least one year, and sometimes two.

What are the benefits of repairing my child’s pectus excavatum?

While most children with pectus excavatum don’t need any treatment at all, more severe cases can be surgically repaired so that your child can lead a normal, active life.

In severe cases, repair of a pectus excavatum may help the function of the heart and lungs. But in most cases, the benefits are mostly psychological. For children who have been upset by their appearance, the surgery can make a big difference.

Pectus Excavatum | Programs & Services