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Pectus excavatum

Pectus excavatum is a condition in which a child's breastbone is sunken into his or her chest. Also called funnel chest or sunken chest, pectus excavatum occurs in about one in 400 births. Pectus excavatum is more common in boys than in girls.

Severe cases of pectus excavatum can eventually interfere with the function of the child's heart and lungs. But even mild cases of pectus excavatum can make children feel self-conscious about their appearance. Surgery can correct the deformity.

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Pectus excavatum

Although the depression of the breastbone is often apparent shortly after birth, most children with pectus excavatum don't begin to experience symptoms until early adolescence. Signs and symptoms may include:

• Decreased exercise tolerance
• Heart palpitations
• Recurrent respiratory infections
• Wheezing or coughing
• Heart murmur
• Fatigue

Pectus excavatum is an inherited condition. It affects the cartilage connecting the ribs to the lower part of the breastbone. Pectus excavatum sometimes occurs in conjunction with:

• Marfan syndrome. This hereditary condition affects the connective tissue, often resulting in limbs and fingers that are especially long and thin.
• Scoliosis. An abnormal curvature of the spine, scoliosis usually occurs in pre-adolescent girls.
• Mitral valve prolapse. The mitral valve separates two chambers in the heart. Defects in the mitral valve may reduce the heart's efficiency in pumping blood.

Risk factors include:

• Sex. Pectus excavatum is more common in boys than in girls.
• Race. White children are more likely to be born with the disorder than are blacks and Hispanics.
• Family history. Pectus excavatum tends to run in families.

Severe cases of pectus excavatum can compress the lungs and push the heart over to one side. Even mild cases of pectus excavatum can result in self-image problems.

You may initially consult your family physician about your child's pectus excavatum. He or she may refer you to a doctor who specializes in orthopedic surgery.

What you can do
You may want to write a list that includes:

• Detailed descriptions of your child's symptoms
• Information about medical problems your child has had in the past
• Information about medical problems common in your family
• All the medications and dietary supplements your child takes
• Questions you want to ask the doctor

What to expect from your doctor
As part of a complete physical exam, your doctor will use a stethoscope to listen carefully to your child's heart and lungs. Other factors to be checked include:

• How deep a breath can your child take?
• Does your child's breastbone dip inward even more during a deep breath?
• Is your child's rib cage unusually rigid?
• Do your child's shoulder blades protrude?
• Does your child routinely tilt his or her head forward?

Pectus excavatum can usually be diagnosed simply by examining the chest. But your doctor may suggest several different types of tests to check for associated problems with the heart and lungs. Tests may include:

• Chest X-ray. This test can visualize the dip in the breastbone and often shows the heart being displaced into the left side of the chest. X-rays are painless and take only a few minutes to complete.
• Computerized tomography (CT). A CT scan may be used to help determine the severity of the pectus excavatum and whether the heart or lungs are compromised. CT scans take many X-rays from a variety of angles to produce cross-sectional images of the body's internal structure.
• Electrocardiogram. An electrocardiogram can show whether the heart's rhythm is normal or irregular, and if the electrical signals that control the heartbeat are timed properly. This test is painless and involves the placement of more than a dozen electrical leads, which are attached to the body with a sticky adhesive.
• Echocardiogram. An echocardiogram is a sonogram of the heart. It can show real-time images of how well the heart and its valves are working. The images are produced by transmitting sound waves via a wand pressed against the chest.

Pectus excavatum can be surgically repaired, but your insurance might not pay for the procedure because it's often classified as cosmetic surgery. Study results have been conflicting about whether surgical repair of pectus excavatum actually improves heart and lung function.

Most people who have had the surgery say it has improved their physical appearance and has made it easier for them to exercise.

Adolescence is a tough time for everyone, but having pectus excavatum can make it even harder. Counseling or support groups may help.