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Pectus Excavatum And Scoliosis
Published on: October 4, 2024
Pectus Excavatum And Scoliosis
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Abigail Ayodele Agbaze

Bachelor of Science in Human Anatomy and Cell Biology, <a href="https://www.delsu.edu.ng/" rel="nofollow">Delta State University</a>, Delta State Nigeria

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Jade Godby

BSc (Hons) in Physiological Science from The University of Bristol. MPAS from St. George’s, University of London

Overview

Pectus excavatum also known as funnel chest is one of the most common structural deformities of the chest wall.1 The sternum and costal cartilage are usually sunken backward with the lower sternum most commonly involved. Thus, the chest wall sinks into the chest cavity.2 This anomaly can be acquired or congenital (present at birth) however 90% of  pectus excavatum is congenital.2,3

Pectus excavatum tends to be noticeable within the first year of life however, it is more visible during puberty.3 In women and adolescent girls, the breast tissue could conceal this defect.4 Notably pectus excavatum is more dominant in males,5 with a ratio of 5:1.6 It has been established that the degree of deformity of pectus excavatum advances with age.7

Causes of pectus excavatum

The cause of pectus excavatum is not fully understood. Several theories have been proposed.2 costal cartilage (cartilage that connects the ribs to the sternum) overgrowth has been the most widely accepted cause of pectus excavatum.8, 9 Also genes may partly be responsible for this deformity as more than 40% of individuals with pectus excavatum have a positive family history.10,11

Signs and symptoms of pectus excavatum

  • Chest pain11,12
  • Fatigue13
  • Dyspnea (shortness of breath) on exertion11
  • Respiratory infection12
  • Asthma12
  • Palpitations11
  • Heart murmur12
  • Displacement of the heart and reduced lung function14, 15
  • Forward-drifted shoulders which could lead to permanent Scoliosis (curving of the spine)13
  • Psychological distress16

Diagnosis of pectus excavatum

The following assessments are performed to thoroughly understand the severity of the deformity and determine treatment options.17They include:

  • History taking and physical examination17
  • Thoracic imaging specifically non-contrast computed tomography (CT) or magnetic resonance (MRI) (images are obtained on both inspiration and expiration)18
  • Electrocardiography17
  • Echocardiography17
  • Blood chemistry analysis (e.g basic metabolic profile)17
  • Complete blood cell counts17
  • Cardiopulmonary exercise testing through measurement of maximum oxygen consumption17
  • Pulmonary function17

Management of pectus excavatum

The management of pectus excavatum includes:

  • Anti-inflammatory medications19,20
  • Osteopathic manipulative treatment19,20
  • Acupuncture19,20
  • Physical therapy19,20
  • Vacuum bell21
  • Corrective Surgery such as The Nuss procedure22

Scoliosis

Scoliosis is a deformity of the spine. It is characterized by a lateral curvature and rotation of the spine. Scoliosis is considered when there is at least a 10-degree curvature.23

Causes

The cause of scoliosis differs.24 Classification includes:

Congenital scoliosis 

Congenital Scoliosis comes about as a result of a spontaneous alteration of the normal spine alignment of the vertebrae in embryonic life.24,25,26

Idiopathic scoliosis

When there are no other underlying health issues, it is termed idiopathic scoliosis. Infantile, juvenile, adolescent, or adult idiopathic forms characterize idiopathic scoliosis depending on its age at onset.

Adult scoliosis can either be an extension of adolescent idiopathic scoliosis or arise independently due to degenerative changes or other reasons that are yet to be known. In older adults, it may be difficult to distinguish between pre-existing idiopathic scoliosis and other underlying degenerative health conditions.27 Additionally, the onset of menopause in females hastens the progression of curvature in older age. 

Neuromuscular scoliosis

Later on in life, neuromuscular scoliosis may arise due to some conditions such as spinal cord trauma, spina bifida, cerebral palsy, or muscular dystrophy. 28

Signs and symptoms

According to the British Scoliosis Society, the following symptoms may occur:

  • The rib cage protrudes on one side, especially at the back
  • Shoulders not being level
  • The hip or waist sticking out 
  • The head tilted over to one side of the trunk
  • Clothes becoming ill-fitting
  • Not being able to stand up straight

Other symptoms include:

  • A difference in breast size in adolescent girls30
  • Chest wall pain on the side of the rib protrusion30
  • A difference between the length of the legs24

Risk factors

The possible risk factors include:

  • Growth alterations31 
  • Posture disorders31
  • Heavy backpacks31
  • Environmental factors31
  • High-risk sports such as ballet dances, gymnastics31
  • Children who have developmental dimorphism31

Management of scoliosis

According to the British Scoliosis Society, scoliosis can be managed through the following methods:

  • Constant monitoring with X-rays and clinical reassessment.
  • Exercise
  • Brace
  • Surgery

Prevalence of pectus excavatum and scoliosis 

Though the prevalence differs widely, scientific investigations have shown a significantly high association between pectus excavatum and scoliosis. 32,33

Cause of co-occurrence 

The specific cause of coexistence remains unclear33 some findings believe that it could be hereditary since patients with both deformities had a family history of either pectus excavatum or scoliosis.34,35 Still,most theories propose that an imbalance in the mechanical forces of the thorax plays a leading role in the coexistence of pectus excavatum and some types of scoliosis.33 In addition surgical correction of either pectus excavatum or scoliosis can either improve, worsen, or lead to the development of either deformity.36,37 

Summary 

Pectus excavatum and scoliosis are deformities of the chest wall and spine respectively. Both malformations can be acquired or congenital. The causes of both deformities are not clearly understood and they may coexist. Surgical and non-surgical interventions have proven to significantly improve the quality of life in sufferers and enhance their cosmetic appearance, thus reducing or eliminating the psychological stress associated with the deformity and improving the patient’s self-esteem.

Reference

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Abigail Ayodele Agbaze

Bachelor of Science in Human Anatomy and Cell Biology, Delta State University, Delta State Nigeria

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