Pectus carinatum, commonly known as “pigeon chest,” is a chest wall deformity where the sternum (breastbone) and ribs protrude outward, giving the chest a bowed or bird-like appearance.
Understanding Pigeon Chest
Pectus carinatum arises when the cartilage connecting the ribs to the breastbone grows abnormally, pushing the sternum forward. While present at birth, it typically becomes more noticeable during periods of rapid growth, particularly in adolescence, around ages 10 to 14. The condition affects males more frequently than females.
The protrusion can be symmetrical, affecting both sides of the chest, or asymmetrical, where one side is more prominent. Medical professionals classify pectus carinatum into two main types: chondrogladiolar, the more common type involving the middle and lower breastbone, and chondromanubrial, a rarer form featuring upper breastbone protrusion. The exact cause for this abnormal growth remains unclear, though a familial history of chest wall abnormalities is observed in a percentage of cases.
Potential Health Concerns
While many individuals with pectus carinatum experience no physical symptoms, the condition can lead to several health concerns, particularly in more pronounced cases. Respiratory issues may arise, including shortness of breath, especially during physical activity. Some patients report exercise intolerance and may experience asthma-like symptoms or recurrent respiratory infections. This can stem from a rigid chest wall that impedes efficient breathing.
Cardiovascular implications, though less common, can include impacts on heart function. Though the heart’s position is generally unaffected in pectus carinatum, there is an association with a higher incidence of mitral valve prolapse, where the heart valve may not function optimally. In rare, severe cases, the chest deformation can directly compress the heart, potentially leading to a faster heart rate or, less commonly, other cardiac abnormalities.
Musculoskeletal discomfort is also a possibility. Individuals may experience chest pain, sometimes linked to specific activities or positions, and back pain. Poor posture, such as hunched shoulders, can also be associated with the condition.
Beyond physical symptoms, the psychological and social impact of pectus carinatum can be significant. The visible nature of the deformity can lead to body image concerns, anxiety, and self-consciousness. These feelings can affect self-esteem and influence social development, particularly in children and adolescents.
Diagnosis and Assessment
Medical professionals diagnose pectus carinatum primarily through a physical examination, which involves visual inspection of the chest. During this assessment, a healthcare provider can evaluate the degree of protrusion and determine if the deformity is symmetrical or asymmetrical. They may also check for associated conditions like scoliosis, an abnormal curvature of the spine.
Imaging techniques are often used to assess chest wall structure and potential impact on internal organs. A chest X-ray provides initial visualization of the sternum and ribs. For a more detailed view, computed tomography (CT) scans or magnetic resonance imaging (MRI) can be performed to precisely measure the degree of protrusion and evaluate possible organ compression. MRI offers the advantage of avoiding radiation exposure.
Functional tests are employed when there are concerns about lung or heart function. Pulmonary function tests, such as spirometry, measure lung capacity and air flow, assessing for any restrictive or obstructive patterns. An echocardiogram may be used to check heart function and detect any cardiac abnormalities, such as mitral valve prolapse, particularly if symptoms suggest a cardiovascular impact.
Management and Treatment Approaches
Management of pectus carinatum varies based on the severity of the protrusion and the presence of symptoms. Non-surgical bracing is a common first-line treatment, especially for adolescents with flexible chest walls. A custom-fitted external compression brace applies gentle, consistent pressure to the protruding sternum, gradually reshaping the chest wall over time. Bracing is most effective when the chest wall is still malleable, typically before skeletal maturity.
Physical therapy and specific exercises can support the treatment process. These interventions aim to improve posture, strengthen chest and back muscles, and enhance respiratory function through breathing exercises. Physical therapy can also help improve overall chest wall mobility.
For severe cases, or when bracing is unsuccessful or not suitable, surgical correction may be considered. The Ravitch procedure, an open surgical technique, involves making an incision to remove or modify the abnormally grown cartilage, then repositioning the sternum. Another approach is a modified Nuss procedure, which uses an internal bar to reshape the chest, similar to its use for pectus excavatum. Surgical decisions are individualized, taking into account the patient’s age, the rigidity of the chest wall, and the presence of significant symptoms or cosmetic concerns.