Introduction

Understanding the causes and symptoms of pectus excavatum is essential for both the affected individual and those seeking to support them.

Pectus excavatum is an abnormal condition in which the ribs and sternum (breastbone) grow inward forming a dent in the chest and giving it a concave appearance.¹ Pectus excavatum is also known as “funnel chest”, “sunken chest” or “cobbler’s chest”. The condition may be mild or severe. Although pectus excavatum is seen as mainly affecting appearance, if it is severe, it may limit lung and heart functions, causing significant compression and shifting of organs in the chest. This might result in serious heart-related symptoms. It happens more often in males than females.^2,5

Pectus excavatum is a congenital condition which means some kids are born with it.^3,4,5 However, most of them will notice it during their early teen years. By the age of 18, when growth typically ends, their conditions also remain.²

In this article, pectus excavatum, its causes, signs and symptoms will be explained in detail. Furthermore, you will gain knowledge about the latest diagnosis and treatment options available. 

Causes of pectus excavatum

The exact cause of pectus excavatum remains unclear but seems to manifest independently or be inherited within families.^2,6 Associated medical conditions include:¹

• Marfan syndrome and Ehlers–Danlos syndrome: A connective tissue disorder
• Poland syndrome: Characterised by incomplete or absent muscle development
• Noonan syndrome: A disorder causing abnormal development in various body parts
• Rickets: Softening and weakening of bones
• Scoliosis: Abnormal curvature of the spine

Symptoms of pectus excavatum

Let’s understand the main signs and symptoms. Symptoms of pectus excavatum can manifest as both physical and psychological.

The key symptoms include:⁷

• Difficulty breathing
• Shortness of breath after exercise or physical activity
• Tiredness
• Heart palpitations (fast beating or pounding heartbeats)
• Chest pain or discomfort
• Emotional struggles like feeling sad or frustrated about the condition
• Self-esteem issues due to aesthetic impairment

Diagnosis

Physicians diagnose pectus excavatum by performing a physical examination of the chest. If necessary, they may also request some additional tests such as:^1,5

• Chest X-ray
• Magnetic resonance imaging (MRI) of the chest
• Computed tomography (CT scan) of the chest
• Electrocardiogram (EKG)
• Echocardiogram
• Lung function tests
• Exercise stress testing

Management and treatment options

The management of a sunken chest, or pectus excavatum, varies depending on the severity of the condition. Treatment options aim to address both physical discomfort and potential complications such as breathing or heart issues. Surgery is often recommended for individuals experiencing significant respiratory or cardiac symptoms. Additionally, alternative treatments such as exercises, targeting improved breathing and posture, as well as vacuum bell therapy, may be suggested. However, it is always advised to consult with a doctor to understand what is the best option for you.

Surgical repair

The two most frequently used surgical methods for correcting pectus excavatum are the Nuss procedure and the Ravitch technique.^1,8,9,10,11

Nuss procedure

• This is a minimally invasive procedure.
• Small cuts are made on both sides of the chest.
• A camera is inserted to help with the surgery.
• A curved metal bar is gently placed under the sunken breastbone.
• This helps lift it to a more natural position.
• The metal bars are usually taken out after a few years.

Ravitch technique

• This is the traditional approach.
• Requires a larger cut along the centre of the chest.
• Surgeons take out the excess connective tissue that pushes the breastbone backwards.
• The sternum (breastbone) is pulled forward to its proper position.
• To keep the breastbone in place, a small plate and tiny screws or a metal bar are used.
• The metal bar is usually removed within six to twelve months after the surgery.

Physical therapy

Doctors may suggest some exercise and physiotherapy for people who do not want surgical repair to ease their symptoms and improve posture.

Vacuum bell therapy

This therapy includes using a unique pump on the chest daily for a few hours. It creates negative pressure, pulling the chest outward to lessen the sunken appearance. While it's more effective for younger children, it's suitable for people of all ages.

FAQs

What is the main cause of pectus excavatum?

The Pectus excavatum is caused by the connective tissue between the ribs and the breastbone growing too much, making the breastbone curve inwards. This creates a noticeable dip or depression in the chest, often looking quite deep.

Does pectus excavatum need treatment?

If you have any physical and physiological symptoms like trouble breathing during or after exercise, chest pain, heart palpitations, tiredness, aesthetic discomfort, or any emotional struggles, your doctor may suggest surgical repair. In the case you don’t have any of these troubles, you can live a normal life without any treatment. The best time for surgical repair is between 10 to 14 years of age as during this time your chest wall is flexible. However, a doctor can help you in deciding the right time for surgery.

Does pectus get worse with age?

As you get older, pectus excavatum is less likely to get worse. However, depending on when it's found, the dip in the chest may become more noticeable as you grow.

Can you live a normal life with pectus excavatum?

Usually, pectus excavatum does not cause major health issues or affect the longevity of yout life. In rare instances, the chest dip could be linked to heart or lung problems, which might indirectly impact how long you live.

Is pectus excavatum a genetic disorder?

The exact cause of pectus excavatum is not clear, but it often runs in families, with more than one sibling being affected in some cases.

Is pectus excavatum a birth defect?

Roughly 95% of chest wall anomalies present at birth are associated with pectus deformities, with pectus excavatum being the most common among them.1 It can occur alone or alongside various other congenital conditions.

What age is pectus excavatum repair?

Doctors usually perform surgery on children between the ages of 12 to 18, but not before the age of 6.¹⁰ It's also possible to do the surgery on adults in their early 20s. However, a doctor can help you decide the right time for surgery.

Summary

Pectus excavatum, commonly known as 'funnel chest' or 'sunken chest,' is a condition where the ribs and breastbone grow inward, creating a concave appearance in the chest. While it can be present from birth, it's often noticed during the teenage years and may not change significantly after the age of 18. The condition can range from mild to severe, impacting lung and heart functions in severe cases. Various factors such as genetic conditions like Marfan syndrome or Noonan syndrome, and skeletal abnormalities like scoliosis, can contribute to its development. 

Symptoms include trouble breathing, chest pain, tiredness, and emotional struggles. Diagnosis involves physical examinations and possibly imaging tests. Treatment options include surgical repair using techniques like the Nuss procedure or Ravitch technique, physical therapy, or vacuum bell therapy. 

Surgery is typically recommended for individuals experiencing significant symptoms, with the ideal age for surgery being between 10 to 14 years old. However, living with pectus excavatum usually does not pose major health risks, and individuals can live normal lives with or without treatment depending upon their symptoms. If you have any further concerns it is advised to consult your doctor to know what is right for you.