What are Chest Wall Deformities?

Chest wall deformities, including Pectus Excavatum (sunken chest) and Pectus Carinatum (protruding chest) come in many shapes and varieties. The two most common types of deformities are sunken chests and protruding chests. The Pediatric Surgeons at Penn State Children’s Hospital treat these common chest wall deformities. One type requires an operation to treat; the other does not.

A “sunken chest”, also called “pectus excavatum” or “depression chest wall deformity” results from the in-turning of the costal cartilages (or “soft bone”) that lie in-between the end of the bony rib and the sternum (breastbone). The sternum appears to sink into the chest and can push on the heart and lungs. The deformity may be visible from infancy, but often becomes more obvious during adolescent growth. In the severe forms of depression chest wall deformity, heart function may be compromised. Exercise intolerance, shortness of breath, and abnormal heartbeat may result. Pediatric Surgeons at Children's Hospital treat patients with depression chest wall deformities. A chest CT scan is used to evaluate the problem in all patients. Our radiologists use a low-dose technique that minimizes exposure to radiation. Some patients may be asked to see a cardiologist, get an EKG or undergo pulmonary function testing as well. Surgical correction involves insertion of a curved metal bar underneath the sternum that literally “pries” the sternum into a more normal position. Insertion of a pectus bar is also referred to as a “Minimally Invasive Repair of Pectus Excavatum (or MIRPE)” since a scope is inserted into the chest to ensure that the bar is passed beneath the sternum safely. The operation is also called the “Nuss Procedure” after the pediatric surgeon who first described the operation. Operations are usually performed on patients with more severe deformities. The operation requires several days in the hospital for recuperation and control of pain and discomfort.  Recuperation at home requires weeks. The bar is removed after three years to assure that the chest will maintain its correct shape. Although surgery and recovery are a big undertaking, patients are most often very happy with the results. Surgical correction is performed on patients 12 years and older, and should not be performed in younger children.

A “protruding chest”, also called “pectus carinatum” or “protrusion chest wall deformity” also results from abnormal growth and shape of the costal cartilages that lie next to the sternum. The protrusion is usually more severe on one side than the other. Protrusion chest wall deformities are rarely seen in young children and typically become obvious during adolescent growth. Unlike depression deformities, surgery is rarely needed for protrusion deformities. Correction relies on the natural “plasticity” of the bones and cartilage of the chest wall.  A custom-fitted external compression brace is worn for hours each day that pushes the chest into a more normal shape. The brace is custom made for each patient and applies firm, gentle pressure to the deformity. The brace is worn inconspicuously under clothing and can be removed for sports and activities. Pediatric Surgeons at Children's Hospital evaluate patients with protrusion chest wall deformities and treat this problem using external compression bracing.

The Pediatric Surgeons at Children’s Hospital treat both pediatric patients (under age 18) and young adults with chest wall deformities. We are happy to evaluate anyone with a concern about a chest wall deformity.

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