Is Pectus Excavatum Serious?

Pectus excavatum is a structural deformity in which a person’s chest looks scooped out and the breastbone sinks into their chest. It can be seen both in children and adults.

Pectus excavatum is a structural deformity in which a person’s chest looks scooped out and the breastbone sinks into their chest. It can be seen both in children and adults.

This hollow in the chest is often noticeable immediately after the birth of the baby. The severity of this condition typically worsens as the baby grows older; it is most rapid during puberty. It is mostly associated with connective tissue and bone disorders, such as scoliosis or genetic conditions (such as Down syndrome). Vitamin D deficiency in utero may also cause the baby to develop a funnel chest. Boys are more affected than girls.

With this condition, the ribs and the breastbone grow in the inward direction. A small funnel-like depression or a slight indentation in the chest is present in a child with mild pectus excavatum. Some kids with the condition may have hunched postures, flared ribs and shoulder blades. This may make a child conscious, depressed and aggressive, resulting in self-image problems. The child may avoid socializing or activities, such as swimming or other sports. In some people, the deepening of the indentation continues in early adolescence and worsening continues till adulthood.

In severe cases, the breastbone (sternum) sinks more deeply into the chest, and it may push the lung and heart to one side. Eventually, there is less room for lung expansion and the heart to beat. This may cause a serious health risk, such as the reduction in the heart’s ability to pump the blood efficiently, resulting in the following complications:

• Rapid heartbeat
• Palpitations
• Heart skipping a beat
• Repeated cold and flu
• Wheezing
• Coughing
• Chest pain
• Shortness of breath
• Heart murmur
• Dizziness
• Fatigue or lethargy
• Low stamina during exercise

The exact cause of pectus excavatum is unknown. However, it may be an inherited condition, which means the condition runs in families. The sunken chest is mostly seen in people with certain genetic conditions, such as

• Marfan syndrome (a genetic connective tissue disorder)
• Ehlers-Danlos syndrome (a genetic disorder of weak connective tissue)
• Osteogenesis imperfecta (a genetic disorder of fragile bones)
• Noonan syndrome (a genetic disorder that affects the development of many parts of the body)
• Turner syndrome (a genetic disorder in girls that affects the development and functions of reproductive organs, such as the ovary and womb)
• Down syndrome (a genetic disorder with chromosome 21)
• Severe vitamin D deficiency (rickets) in utero or severe osteomalacia in a pregnant woman

Surgery can correct this deformity, but it is usually reserved for people who have moderate to severe features and symptoms. Consult the pediatrician about the child’s condition, and the doctor might recommend surgery.

Depending on the extent of the condition, two types of surgeries can be performed:

1. Thoracotomy: In this surgery, the surgeon makes a large cut or incision on the center of the chest for better and direct visibility through the breastbone. The cartilage (connective tissue) that connects the ribs to the breastbone will be removed. The metal bars and other tools will be used to move the breastbone to a typical position.
2. Thoracoscopic surgery: During this type of surgery, the surgeon makes two to three keyhole-sized cuts under each arm. A long flexible tube with a camera will be inserted through this incision. Then the surgeon will place a small metal bar along the chest wall to move the breastbone to a typical position.

The doctor might not recommend surgery if the problem is less severe. In this case, psychological counseling and support are provided to deal with this condition and make the child socialize with others.