Pectus Excavatum

Pectus Excavatum

Pectus Excavatum, which is also termed as sunken or funnel chest, is a congenital chest wall deformity, in which there is an abnormal growth of some of the ribs and the sternum. This leads to a concave, or caved-in, appearance in your anterior chest wall. The condition occurs both in children, as well as adults, though it is mostly seen in the early teen years.

Symptoms

Due to this condition, patients may have less space in their chest, and this can lead to their heart and lung function getting limited. The symptoms may be physical or psychological. The physical symptoms generally include the following:

 

Aside from this, the condition can also lead to a few psychological conditions such as:

  • Embarrassment due to the appearance of the chest
  • Depression
  • Self-esteem issues

 

If you or your child, shows any of the symptoms, you might want to consider seeing a healthcare professional.

Causes

What exactly causes pectus excavatum is unknown. However, there are few medical problems which are associated with this condition, some of them including:

  • Marfan Syndrome- A connective tissue disease
  • Noonan Syndrome- This disorder can cause abnormal development of several parts of the body
  • Poland Syndrome- A disorder that causes the muscles to develop slowly or not develop at all
  • Scoliosis, a condition which causes abnormal curving of the spine
  • Rickets, a softening and weakening of the bones

Diagnosis

The diagnosis of this condition is made with a physical examination. Generally, the defect is not noticeable in a child, until the early teen years. Chest imaging by MRI or ST scan, or cardiopulmonary exercise testing, can help to accurately measure the seriousness of the condition, as well as its effect on cardiopulmonary function. Other tests that might be used to diagnose this condition include echocardiogram and pulmonary function tests.

Treatment

Pectus excavatum is treatable surgically. Surgery is generally advised if the condition causes other health problems, such as difficulty in breathing. It can also be done to improve the appearance of the chest. Discuss treatment options with your provider.

The Nuss procedure

This method involves a small camera being inserted into the chest, to guide the procedure. Then two small incisions are made on either side of the chest, after which a curved steel bar is inserted under the sternum. Individually curved for a patient, this bar helps to correct the depression and is secured to the chest wall on both sides. For three years, the bar is left in this place and position, and it is removed later as an outpatient procedure.

The Ravitch procedure

This procedure, which is also known as ‘traditional’ or open surgical repair, of pectus excavatum, involves an incision on the front of the chest with the removal of the cartilaginous part of the ribs, as they have overgrown, and caused the sternum to be pushed in a backward direction. Thus, the sternum can be pulled forward, away from the heart and lungs, and into the normal plane of the wall of the chest. Often, a small plate with tiny screws might be used to help stabilize the sternum in the new position. A small metal bar might also be placed behind the sternum for six to twelve months. It can be removed later during a short outpatient procedure. This bar is smaller than the one which is used in the Nuss procedure.

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