Pectus Excavatum

Pectus excavatum is an abnormal inward curve to the breastbone. It may be visible at birth. Growth through adolescence can make the indentation of the chest more apparent. It may continue until it has created a bowl-shape dent in the center of the chest. Severe forms can create extra pressure on the heart and lungs. This can lead to more serious health problems like shortness of breath and limited physical activities.

  • Causes

    The exact cause of pectus excavatum is not known. Some theories include:

    • Pressure in womb during pregnancy
    • Excessive pulling on breastbone and rib cage from shortened tendons of diaphragm muscles
    • Abnormalities in cartilage of the rib cage
    • Genetic factors
    The Rib Cage
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    Pectus excavatum may also be caused by conditions that affect connective tissue or chest structure, such as:

    • Scoliosis
    • Marfan syndrome
    • Ehlers-Danlos syndrome
    • Asphyxiating thoracic dystrophy (rare genetic disorder)

  • Definition

    Pectus excavatum is an abnormal inward curve to the breastbone. It may be visible at birth. Growth through adolescence can make the indentation of the chest more apparent. It may continue until it has created a bowl-shape dent in the center of the chest.

    Severe forms can create extra pressure on the heart and lungs. This can lead to more serious health problems like shortness of breath and limited physical activities.

  • Diagnosis

    Your doctor will:

    • Ask about your symptoms
    • Take your medical history
    • Do a physical exam

    Your doctor will often be able to diagnose pectus excavatum after a physical exam.

    Additional tests may be done to find out if your heart or lungs are affected. These tests may include:

    • CT scan
      —a type of x-ray that uses a computer to make pictures of structures inside the chest. This is done to determine if the heart is squashed in the chest.
    • Pulmonary function test
      —a group of tests done to assess breathing ability. They will assess if your lungs have any difficulty moving adequate amounts of air.
    • Electrocardiogram
      (ECG, EKG)—a test that records the heart’s activity by measuring electrical currents through the heart muscle
    • Echocardiogram
      —a test that uses sound waves (ultrasound) to examine the size, shape, and motion of the heart.

  • Prevention

    There is no known way to prevent this condition.

  • Risk Factors

    Risk factors include:

    • Family history of pectus excavatum
    • Gender: more common in boys

    Complications from pectus excavatum tend to increase with age due to bone growth and a decrease in the flexibility of the bones.

  • Symptoms

    Pectus excavatum is characterized by an indentation in the front of the chest wall. It may be mild or deep enough to form a bowl shape.

    If the indentation is severe enough to affect the heart or lungs you may also have:

    • Difficulty exercising
    • Unexplained shortness of breath
    • Mild chest pain

    • Frequent respiratory tract infections (eg,
      cold
      ,
      bronchitis
      ,
      pneumonia
      ) that last longer than normal

    A person with this condition may not have any symptoms during childhood. But as the person grows into an adolescent, he may have symptoms because of of a more pronounced indentation in the chest wall.

  • Treatment

    Talk with your doctor about the best treatment plan for you. Options include: