Chest Wall Deformities
Also known as . . . Pectus,
Pectus excavatum, Pectus carinatum, sunken chest, pigeon breast
What is it?
A chest wall deformity is a condition in which the chest
wall has an abnormal configuration. Chest wall deformities are typically divided into two
broad categories: pectus excavatum, and pectus carinatum. In pectus excavatum the chest
has a sunken in or excavated appearance. In pectus carinatum the chest protrudes forward,
much like the breast of a bird.
Although on first inspection, chest wall deformities would
appear to be the result of an abnormally growing sternum (breastbone), chest wall
deformities are actually the result of abnormally growing rib cartilages. This abnormal
growth of the rib cartilages pushes the sternum either inward toward the spine, or
outward, away from the plane of the chest. The deformities can range in severity from
mild, symmetric indentations or protrusions, to very severe asymmetric deformities. The
appearance of the deformity often changes dramatically around the time of adolescent
growth.
Despite their distressing appearance, chest wall
deformities by themselves usually have little impact on heart or lung function. (I.e. they
are an anatomic, more than a physiologic problem.) Unusual conditions such as
Marfan’s Syndrome, or Poland’s Syndrome may have cardiac, blood vessel, or limb
abnormalities associated with the obvious chest wall deformities. Many patients with chest
wall deformities are quite active in physically demanding activities including athletics.
Treatment of Chest Wall Deformities
Currently there are two operations performed for chest
wall deformities. The traditional operation (referred to as a Ravitch procedure) involves
making an incision across the chest and removing the abnormal rib cartilages. The sternum
is then fractured (broken) and repositioned. A metal pin is usually placed through the
sternum to hold the bone in the desired position while healing occurs. A short outpatient
procedure is performed 6 months later to remove the pin. During the interval between
operations, a chest protector is worn to reinforce the unstable chest wall and protect
underlying structures. Activity is restricted (no sports). This procedure is applicable
for both pectus excavatum and pectus carinatum.
The second procedure (known as the Nuss procedure)
involves passing a pre-shaped bar across the chest just underneath the sternum. This is
accomplished by means of two small incisions on either side of the chest. A small surgical
viewing scope (thoracoscope) is also placed into the chest to visualize the safe passage
of the bar across the chest. The bar remains in place for two years and is removed at the
end of that time in a short outpatient procedure. The chest wall is not unstable during
this time; therefore, activity is not restricted. Currently the Nuss repair is offered
only for excavatum type deformities. The best candidates for this procedure are pre-teen
patients with relatively symmetric deformities. The inpatient hospital stay for both types
of repair is typically about three days.
Glossary of Terms
Pectus excavatum: a chest wall deformity in which
the chest wall takes on a sunken appearance
Pectus carinatum: a chest wall deformity characterized by
a protrusion of the sternum
Marfan Syndrome: a condition occasionally associated with
chest wall deformities, in which the patients have a characteristic tall thin appearance,
cardiac, and great vessel abnormalities
Poland Syndrome: another condition associated with chest
wall deformities, in which varying degrees of underdevelopment of one side of the chest
and arm may occur
Physicians in the Division of Pediatric
Surgery at Penn State Children’s Hospital treat chest wall deformities using both
techniques. We have a team of surgeons, anesthesiologists, nurses and child life
specialists dedicated to providing both you and your child with the best operative
experience possible. We believe it is important to reduce pre-operative anxiety and to
control post-operative pain and discomfort.
Physician's Who Treat Chest Wall Deformities
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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