Pectus excavatum, often called “sunken chest” or “funnel chest,” is the most common congenital chest wall deformity. This condition is characterized by the sternum and costal cartilage growing abnormally inward, creating a depression in the center of the chest. While present at birth, the indentation frequently becomes more noticeable during rapid growth phases, such as adolescence. The severity varies widely, ranging from a slight dip to a deep hollowing.
Identifying the Physical Signs
The primary indicator of pectus excavatum is a visible concavity in the anterior chest wall, where the sternum sinks toward the spine. This indentation can be localized to the lower third of the breastbone or present as a broader depression involving the upper rib cartilages. The depth of the hollowing determines the classification of the condition as mild, moderate, or severe.
The deformity may be symmetrical, with the sternum dipping directly inward, or asymmetrical, causing the sternum to rotate and the depression to be deeper on one side. An associated feature is the flaring or outward protrusion of the lower ribs, which results from the inward sternal pressure. Individuals with a significant deformity often adopt a hunched-forward posture with rounded shoulders.
Associated Symptoms and Functional Impact
While mild cases may only present a visual change, moderate to severe cases can lead to physical symptoms due to the compression or displacement of internal organs. The sunken sternum reduces the space available for the heart and lungs, limiting their full function. This restriction often manifests as shortness of breath, particularly during physical activity.
The heart may be displaced, typically pushed to the left side of the chest. Compression can affect the heart’s ability to fill and pump blood efficiently, especially during exertion. This results in a rapid heart rate or a fluttering sensation called palpitations. Individuals often experience reduced endurance and exercise intolerance, tiring more quickly during rigorous activities. Chest or back pain is also a frequent complaint, stemming from abnormal stress placed on the musculoskeletal structure and poor posture.
Understanding the Causes and Risk Factors
The exact cause of pectus excavatum remains unclear. The prevailing theory points to an abnormal, excessive growth of the costal cartilage, which connects the ribs to the sternum. This overgrowth pushes the breastbone inward, leading to the characteristic concave appearance. The condition frequently progresses and deepens during periods of rapid skeletal growth, such as the pubertal growth spurt.
While not strictly genetic, there appears to be a hereditary component, as approximately 40% of people with the condition have a family member affected. Pectus excavatum is also associated with certain connective tissue disorders, including Marfan syndrome and Ehlers-Danlos syndrome. These associations suggest that issues with the structural integrity and elasticity of connective tissues may contribute to the deformity.
Next Steps: Diagnosis and Treatment Overview
If you suspect you have pectus excavatum, the first step is to consult a physician for a thorough physical examination. To objectively measure the severity of the condition and its impact on internal organs, a healthcare provider will typically order specialized tests. A Computed Tomography (CT) scan is commonly used to calculate the Haller Index, a numerical ratio that compares the width of the chest cavity to the distance between the sternum and the spine. A higher number indicates a greater degree of severity.
Further diagnostic tools include pulmonary function tests to evaluate lung capacity and an echocardiogram to check the heart’s function and position. The results of these tests guide the treatment plan, which is individualized based on the symptoms, the severity of the deformity, and the patient’s age.
Non-Surgical Options
For mild cases with no functional symptoms, observation, physical therapy to improve posture, or non-surgical options may be recommended. The vacuum bell is one such device, placed on the chest, that uses suction to gently lift the sternum outward over time. This treatment is often used in younger patients with flexible chest walls.
Surgical Correction
For moderate to severe cases, or when cardiopulmonary function is compromised, surgical correction is generally considered. The most common approach is the minimally invasive Nuss procedure. In this procedure, a curved metal bar is threaded beneath the sternum and rotated to push the breastbone into a corrected position. The bar remains in place for two to three years before being removed in a second procedure.
An older, more invasive technique is the Ravitch procedure, which involves a larger incision to remove the deformed costal cartilage and reposition the sternum. The Ravitch procedure is reserved for older patients with stiffer chest walls, asymmetrical deformities, or those who have had a recurrence after the Nuss procedure.