Pectus excavatum is a congenital chest wall deformity characterized by an inward depression of the breastbone, also known as the sternum. This condition gives the chest a sunken or caved-in appearance, sometimes referred to as funnel chest. It results from abnormal growth of the cartilage connecting the ribs to the sternum. Pectus excavatum is the most common chest wall abnormality, affecting approximately 1 to 8 out of every 1,000 people and occurring more frequently in males.
Progression Across the Lifespan
The severity of pectus excavatum can change over an individual’s lifetime, often becoming more noticeable during periods of rapid growth. While subtle at birth, the indentation may become more apparent in childhood.
The most significant worsening typically occurs during adolescence, particularly during puberty and associated growth spurts, due to rapid chest wall and cartilage growth. A mild deformity can progress to a more severe or asymmetric form within 6 to 12 months, potentially complicating surgical repair if delayed.
Once an individual reaches adulthood, the progression of pectus excavatum usually stabilizes. Further worsening of the chest’s depth or deformity is less likely.
Associated Symptoms and Health Impacts
Progression of pectus excavatum can lead to physical and psychological symptoms. In severe cases, the sunken sternum and ribs can compress the heart and lungs, affecting their function.
This compression may result in reduced lung capacity, leading to shortness of breath, fatigue, and exercise intolerance. Some individuals experience chest pain or a fast heartbeat. The sternum’s proximity to the pulmonary artery can also cause a heart murmur.
While mild cases may not present with physical symptoms during ordinary activities, rigorous exercise can reveal limitations. Beyond physical effects, the visible chest deformity can lead to body image concerns and psychosocial impacts, particularly in adolescents, sometimes causing withdrawal from physical activities.
Factors Influencing Severity and Progression
Several factors contribute to the severity and progression of pectus excavatum. Genetic predisposition plays a role, with approximately 40% of affected individuals having family members with the condition, suggesting an inherited component.
Rapid skeletal growth, particularly during puberty, is a driver of progression as the chest wall undergoes substantial changes. Pectus excavatum can also be associated with connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome. These conditions involve systemic weakness of connective tissues, influencing the deformity’s development and worsening.
Monitoring and Management Approaches
Regular medical evaluation is important for monitoring pectus excavatum. Diagnostic tools include visual examination and imaging like CT scans to measure the Haller Index, which quantifies indentation severity. A Haller Index greater than 3.25 is often considered severe and may indicate candidacy for surgical intervention. Functional tests like pulmonary function tests and echocardiograms assess heart and lung function.
Non-surgical management options include physical therapy to improve posture and chest wall mobility, and vacuum bell therapy. Vacuum bell therapy involves placing a suction cup device on the chest to gently pull the sternum forward, and it is more effective for younger patients with flexible chest walls.
Surgical interventions are considered for more severe cases, particularly if symptoms are present. The two main surgical procedures are the minimally invasive Nuss procedure and the traditional Ravitch technique. The Nuss procedure involves placing a metal bar under the sternum to push it outward, typically left in place for two to three years. The Ravitch technique involves removing deformed cartilage and repositioning the breastbone. Treatment decisions are individualized, considering the deformity’s severity, symptom presence, and the patient’s age.