Chest Wall Disorders
Overview
A chest wall disorder is when a child is born with an unusually shaped breastbone. The two most common chest wall disorders are:
Pectus carinatum, or “pigeon chest”. When a child is born with a breastbone that curves outward in an unusually exaggerated way.
Pectus excavatum. When a child is born with an unusually sunken breastbone, giving the chest a “scooped out” appearance.
Often, chest wall disorders are not very noticeable in babies or young children but can become more noticeable as they enter puberty and adolescence. Many children with a chest wall disorder will not notice any symptoms other than an unusual physical appearance. However, children with pectus carinatum or pectus excavatum who feel self-conscious or have health complications due to their unusual chest shape may want to seek treatment.
Symptoms of Chest Wall Disorders
Signs and symptoms of chest wall disorders can include:
Asthma
Chest pain
Chest that curves unusually (in or out)
Coughing
Fast heartbeat
Fatigue
Heart murmur (extra sound during heartbeat)
Heart palpitations (beating too fast, too hard or fluttering)
Inability to exercise for long periods of time
Repeated respiratory infections
Shortness of breath, especially during exercise
Wheezing
When to see a doctor
If your child is experiencing shortness of breath, chest pain or other symptoms, they should see their pediatrician for proper diagnosis and treatment. If your child is bothered by the appearance of their chest wall disorder, treatment may be helpful.
Causes of Chest Wall Disorders
Chest wall disorders are caused by a genetic defect present at birth.
Who’s at risk
If someone in your family has a chest wall disorder, you may be at an increased risk of having a baby with the condition. If your child has any of the following genetic health conditions, they may be at an increased risk of having a chest wall disorder:
Down syndrome
Edwards syndrome (affects growth)
Ehlers-Danlos syndrome (causes problems with collagen, a substance that adds strength and elasticity to the body’s connective tissues)
Homocystinuria (prevents the body from processing certain proteins correctly)
Marfan syndrome (affects the body’s connective tissue)
Morquio syndrome (affects the bones, spine, organs and physical abilities)
Noonan syndrome (causes short stature, unusual facial features, bleeding problems and other complications)
Osteogenesis imperfecta (affects the bones)
Turner syndrome (causes short stature, ovary development failure and heart problems in females)
Diagnosis of Bronchopulmonary Sequestration
Your child’s pediatrician will start checking for this condition with a physical exam. They will also consider your child’s personal and family medical history. From there, their doctor may refer your child to a pediatric surgeon for further evaluation. Upon evaluation by the surgical team, your child may also be referred to other specialists including cardiology (heart), pulmonology (lung) and genetics when needed. Throughout this process, any of the specialists or their pediatricians may order one or more of the following tests to diagnose a chest wall disorder:
Computerized tomography (CT) scan. This imaging test uses a specialized X-ray to create detailed pictures of the inside of your child’s chest, including the heart and lungs. A measurement called a “Haller Index” will be taken to determine the severity or degree of their condition.
Echocardiogram (ECG). This test uses sound waves to create detailed images of your child’s chest, including the heart and lungs.
Electrocardiogram (EKG). This test checks if your child’s heart rhythm and electrical signals are functioning normally.
Exercise stress test. This test checks how your child’s heart and lungs work during exercise.
Lung function test. This test checks to see if your child’s chest wall disorder affects how well their lungs work.
Ultrasound. This imaging test uses sound waves to create detailed pictures of your child’s chest, including the heart and lungs.
X-ray. This common imaging test uses radiation to create detailed pictures of the inside of your child’s chest, including the heart and lungs.
Treatments for Bronchopulmonary Sequestration
If your child has a chest wall disorder, their doctor may recommend one or more of the following treatment options:
Bracing. Wearing temporary specialized braces may help alter your child’s chest appearance. Many people notice a difference with bracing in just a few months. This is the most common treatment for pectus carinatum.
Physical therapy. Working with a specially trained physical therapist may help improve your child’s posture.
Surgical repair. If your child is experiencing moderate to severe complications related to a chest wall disorder, their surgeon may recommend surgery. Depending on your child’s exact situation and needs, surgery could involve using temporary or permanent implants. Typically, a metal bar is placed and loft for a prolonged period of time. The surgeon will determine when the metal bar can be removed. Our surgeons offer two different approaches, including the Ravitch and the Nuss procedures. The most suitable approach for each child is determined on an individual basis.
Contact Us
If you suspect that your child may have Chest Wall Disorders, make an appointment with an Orlando Health pediatrician today so your child can start on the road to improved health.
