Pectus excavatum is a common chest wall deformity where the sternum and several ribs grow abnormally, causing the chest to cave inward. Also known as “funnel chest” or “sunken chest,” it is often noticed at birth but can become more pronounced during rapid growth phases like adolescence.
Visual Characteristics of Pectus Excavatum
Pectus excavatum appears as an indentation in the anterior chest wall, primarily affecting the sternum and connected ribs. This depression varies significantly in depth and shape. The most severely affected area often appears around the xiphisternum, the small cartilaginous process at the bottom of the sternum.
A distinct dip or scooped-out appearance is common in the center of the chest. Some individuals have a slight indentation, while others have a much deeper depression. The deformity can be symmetrical, appearing evenly across the chest, or asymmetrical, causing one side to appear more sunken. Sometimes, the lower ribs may also flare outwards.
Understanding Severity and Types
The visual appearance of pectus excavatum provides clues about its severity, ranging from mild to severe. Mild cases show a less pronounced depression, often causing minimal physical symptoms but potentially leading to aesthetic concerns. Moderate pectus excavatum features a more noticeable chest depression, which may be associated with symptoms like breathing difficulties or fatigue during physical activity.
Severe pectus excavatum involves a deeper, more pronounced chest indentation that can press on internal organs, potentially affecting heart and lung function. Beyond severity, the deformity also comes in different shapes. These include “cup-shaped,” a more localized indentation, or “saucer-shaped,” a broader, more widespread depression across the chest. Some severe forms might appear “trench-like,” resembling a deep, longitudinal groove that can extend from the upper chest down to the abdominal wall, sometimes following a diagonal path.
Diagnostic Imaging for Pectus Excavatum
Beyond external observation, medical imaging assesses pectus excavatum and its impact on internal structures. X-rays provide images of the breastbone’s dip and may show the heart displaced towards the left side of the chest. They can also reveal findings like slanted anterior ribs and narrowing of the mediastinum.
Computed tomography (CT) scans and magnetic resonance imaging (MRI) offer more detailed cross-sectional views, precisely assessing the deformity’s extent. These scans help visualize if the heart or lungs are compressed due to the inward sternum. The Haller Index, a common measurement, is calculated from CT or MRI images by comparing the chest’s transverse diameter to its narrowest anteroposterior distance at the point of greatest depression, with a ratio over 3.25 indicating significant pectus excavatum. MRI is favored over CT to avoid radiation exposure, particularly for younger patients who may require repeat imaging.
Visualizing Treatment and Outcomes
Images illustrate the changes observed after pectus excavatum treatment. Before-and-after photographs display the correction of the chest wall indentation. These visual comparisons highlight the improved cosmetic appearance and a more normalized chest contour.
They demonstrate the effectiveness of various interventions, whether surgical or non-surgical. For instance, pictures can show the results of the Nuss procedure, a minimally invasive surgical technique that repositions the sternum, or the outcome of vacuum bell therapy, a non-invasive option for milder cases. The visual transformation seen in these images reflects not only physical correction but also an enhancement in self-confidence and overall quality of life.