Pectus excavatum, also known as funnel chest or sunken chest, is a common chest wall deformity where the breastbone appears sunken. This condition involves an abnormal inward growth of the sternum and several ribs. It is the most frequent congenital chest wall abnormality, affecting approximately 1 to 8 out of every 1,000 live births. While often present at birth, the indentation may become more noticeable during rapid growth periods, such as puberty.
Understanding the Condition’s Spectrum
Pectus excavatum exists across a broad spectrum of severity, ranging from mild indentations that are primarily cosmetic to severe cases that can influence internal organs. Not all individuals with this condition experience significant physical symptoms, and many lead lives without major physical limitations. The degree of indentation can vary considerably, affecting the lower end of the sternum in a cup-shaped concavity, or sometimes a broader area involving upper costal cartilages. Some cases may also exhibit asymmetry, where one side of the chest is more affected than the other.
Potential Health Implications
In severe cases, the inward displacement of the sternum can physically compress or displace the heart and restrict lung expansion. This compression can lead to various cardiovascular symptoms, including chest pain, heart palpitations, and an irregular heartbeat. The heart, located behind and slightly to the left of the sternum, may be pushed out of its normal position, potentially affecting its function. Individuals with pectus excavatum can experience reduced cardiac output and lower stroke volume during exercise, leading to symptoms like reduced exercise tolerance, increased heart rate, and fatigue during physical activity.
The caved-in chest can limit the space available for the lungs to expand fully, resulting in shortness of breath, especially during exertion, and potentially reduced lung capacity. Although simple lung function tests might appear normal, more sophisticated tests during exercise can reveal a reduced pulmonary reserve. Beyond physical effects, the visible chest deformity can also lead to psychological impacts, such as self-consciousness, body image concerns, and social anxiety, particularly in adolescents.
Assessing Severity and Need for Intervention
Medical professionals determine the severity of pectus excavatum and its potential impact through a comprehensive evaluation. A physical examination is typically the initial step, where the clinician assesses the depth and symmetry of the chest indentation. Imaging techniques play a role in quantifying the deformity and its effect on internal structures. A computed tomography (CT) scan of the chest is commonly performed to calculate the Haller Index, a widely used measure of severity. This index is the ratio of the chest’s transverse diameter to the shortest distance between the sternum and the spine, with a value over 3.25 often indicating a severe case.
Magnetic resonance imaging (MRI) can also be used for detailed morphological assessment. Functional tests further evaluate the condition’s physiological impact. Pulmonary function tests (PFTs) measure lung capacity and airflow, while echocardiograms assess heart compression and overall cardiac function. Cardiopulmonary exercise tests track how well the heart and lungs perform during physical activity, helping to identify limitations that might not be apparent at rest. These diagnostic methods help determine if the condition is causing significant physiological impairment that warrants intervention.
Addressing the Condition
Management of pectus excavatum varies depending on the severity of the condition and the presence of symptoms. For milder cases, non-surgical options are available. Physical therapy can help improve posture and increase chest wall flexibility. Vacuum bell therapy involves placing a suction cup-like device on the chest to gradually pull the breastbone forward over several months. This non-invasive approach is often considered for younger patients with flexible chest walls and less severe indentations.
For more severe or symptomatic cases, surgical intervention may be recommended to relieve pressure on the heart and lungs and improve chest appearance. The Nuss procedure is a minimally invasive technique where a curved metal bar is inserted under the sternum to push it outward, remaining in place for a few years before removal. Another surgical option is the Ravitch procedure, an open surgery that involves removing deformed cartilage and repositioning the sternum.