Pectus excavatum, often recognized as “sunken chest” or “funnel chest,” is a common chest wall deformity where the breastbone appears to be sunken into the chest. This condition is present in approximately 1 in 400 to 1,000 live births, affecting males more frequently than females. A common concern for individuals and their families is whether this indentation will deepen or cause more issues over time. Understanding the typical progression of pectus excavatum is helpful for those navigating this condition.
How Pectus Excavatum Develops and Changes Over Time
Pectus excavatum is a congenital condition, though it may not always be immediately noticeable at birth. While some cases remain stable throughout life, the deformity often becomes more pronounced during periods of rapid growth. The most significant changes occur during adolescence, particularly during puberty, when the chest wall undergoes substantial bone and cartilage growth.
During these growth spurts, the inward growth of the ribs and sternum can accelerate, making the indentation deeper or more asymmetrical. This progression is related to the disproportionate growth of the costal cartilages, which connect the ribs to the breastbone. Once an individual reaches adulthood, the progression of pectus excavatum stabilizes. However, the physical and functional effects present at that time are likely to persist.
Factors Influencing Progression
Several factors can contribute to the progression of pectus excavatum. Genetic predisposition plays a role, with studies indicating that 40% to 53% of affected individuals have family members with the condition. While a single gene has not been identified, familial clustering suggests a hereditary influence.
The individual’s growth rate and timing of growth spurts are also important. Rapid increases in height and bone development during adolescence can exacerbate the inward pull on the sternum. Certain underlying conditions, particularly those affecting connective tissue, can influence severity and progression. These include syndromes like Marfan, Ehlers-Danlos, and Noonan, which are associated with weakened connective tissues. The presence of these conditions can lead to more severe deformities and complications.
Signs of Worsening Pectus Excavatum
Worsening pectus excavatum can manifest through physical and functional changes. Physically, there may be a noticeable increase in the depth or asymmetry of the sternal depression. The lower ribs might also appear to flare out more prominently, a condition known as rib flare.
Functional symptoms often become more apparent during physical activity. Individuals may experience new or increased shortness of breath and reduced exercise tolerance. This can make it difficult to keep up with peers during sports or other activities. Other indicators include chest pain, particularly with exertion, heart palpitations or a fast heartbeat, and fatigue. These symptoms arise when the sunken breastbone compresses the heart and lungs, limiting their ability to function optimally.
When to Seek Medical Consultation
Regular monitoring is important, especially during periods of rapid growth, to assess any changes in the pectus excavatum. If there are concerns that the condition is worsening, or if new physical or functional symptoms arise, consulting a healthcare professional is advisable. A medical evaluation begins with a physical examination of the chest.
Further assessment may involve imaging tests to determine the indentation’s severity and its impact on internal organs. These tests can include a chest X-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI) to visualize the deformity’s depth and potential compression of the heart or lungs. Additionally, functional tests like pulmonary function tests (PFTs) to measure lung capacity and echocardiograms to assess heart function may be performed. An exercise stress test can also evaluate how well the heart and lungs perform during physical activity. Early assessment allows for informed monitoring and discussion of management strategies.