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What Is Pectus Carinatum?
Pectus carinatum is a congenital chest wall abnormality in which the chest sticks out more than it should. It happens because the sternum (breastbone) and ribs grow outward, causing the chest to protrude.
Because the chest looks bird-like, pectus carinatum is also called pigeon chest.
Although pectus carinatum can be present at birth, about 90% of cases are diagnosed after a child's 11th birthday. It often gets worse during growth spurts.
Pectus carinatum can range from mild to severe. In severe cases, it can affect the heart and lungs and make it hard to exercise. People may also struggle with body image or self-esteem because of how their chest looks.
What are the types of pectus carinatum?
There are two types of pectus carinatum:
- Chondrogladiolar prominence — When the middle and bottom portions of the sternum protrude forward. It's the more common type of pectus carinatum.
- Chondromanubrial prominence — When the top portion of the sternum sticks out and the bottom portion is pushed inward.
What causes pectus carinatum?
The exact cause of pectus carinatum isn't known. It can occur in families with a history of pectus carinatum or other chest wall abnormalities. Other causes may include abnormal growth of the ribs, sternum, or the cartilage connecting the ribs and sternum.
Though most children with pectus carinatum do not have other conditions, it can also occur with:
- Cardiofaciocutaneous syndrome.
- Homocystinuria.
- Marfan syndrome.
- Morquio syndrome.
- Multiple lentigines syndrome.
- Noonan syndrome.
- Osteogenesis imperfecta.
- Scoliosis.
What are pectus carinatum risk factors and complications?
Pectus carinatum risk factors
Risk factors for pectus carinatum include:
- Family history — People whose family has a history of pectus carinatum or other chest wall abnormalities are more at risk of having pectus carinatum.
- Other health conditions — Certain genetic diseases or connective tissue disorders are associated with pectus carinatum.
- Sex — Males are more likely to have pectus carinatum than females.
Complications of pectus carinatum
Pectus carinatum can range from mild to severe. In severe cases, it can cause heart or lung problems.
People also may suffer from body image, self-esteem, or other mental health burdens because of how their chest looks.
How common is pectus carinatum?
About 1 in 1,500 children have pectus carinatum, making it the second most common congenital chest wall anomaly. It occurs four times more often in males than females.
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What Are the Signs and Symptoms of Pectus Carinatum?
The clearest sign of pectus carinatum is a protruding chest in the area of the sternum (breastbone) and ribcage. The condition often doesn't cause other physical symptoms.
In more severe cases, people may experience heart and lung issues, including:
- Asthma.
- Chest pain.
- Heart palpitations.
- Respiratory infections.
- Shortness of breath, especially during exercise.
When should my child see a doctor about pectus carinatum symptoms?
Talk to your child's doctor about getting a referral to a pediatric thoracic (chest) specialist if they are having heart- or lung-related problems.
They should also see a doctor if their condition is causing mental health issues, such as with body image or self-esteem. Treatment can help fix the look of the chest and relieve other symptoms.
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How Do You Diagnose Pectus Carinatum?
Primary care providers or pediatricians can diagnose pectus carinatum. They might also consult a pediatric thoracic (chest) specialist or surgeon.
The doctor will ask when you noticed the chest abnormality and whether your child has any other symptoms, other health conditions, or a family history of chest wall abnormalities.
The doctor will also perform a physical exam on your chest to diagnose pectus carinatum. They may also order imaging tests to help confirm the diagnosis.
Tests to diagnose pectus carinatum
The doctor may order imaging tests to determine how severe the condition is, such as:
If your child has symptoms related to their heart or lungs, the doctor may order:
The doctor may also order genetic or blood tests to see if your child has any other conditions associated with pectus carinatum.
Pectus carinatum prognosis
Treatment can help correct the look of the chest and relieve symptoms.
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What Are the Treatment Options for Pectus Carinatum?
Many people with pectus carinatum don't need treatment. But if the child has heart or lung symptoms or doesn't like the look of their chest, they may need treatment.
The doctor will discuss the treatment options with you to help determine a treatment plan.
Treatment for pectus carinatum typically does not require surgery; however, in rare cases, surgery may be recommended.
Nonsurgical treatments for pectus carinatum
Bracing
Bracing is often the first-line treatment for people with moderate to severe pectus carinatum and a flexible chest wall.
For this treatment, you wear a soft, compressible brace over the chest, typically for around six months. Over time, the brace can help the chest return to its normal position.
Typically, a person must wear the brace for 23 hours a day for three to six months, removing it only for showers and exercise. As the chest's appearance improves, they can progress to only wearing the brace at night, as recommended by the doctor.
Bracing can be successful if the person wears the brace as recommended. The treatment has a lower chance of success if the child doesn't follow the schedule for wearing the brace.
People often can begin this treatment as soon as they're old enough to follow the orders for wearing the brace. Younger children may have trouble following their doctor's recommendations.
Physical therapy
Doctors also may recommend physical therapy (PT) to strengthen the chest muscles. PT may be part of the treatment plan in addition to bracing.
Surgery for pectus carinatum
Surgery is an option for pectus carinatum in rare cases, such as if the person has a severe condition or if bracing doesn't work. The modified Ravitch procedure is the main option. It is performed by a pediatric thoracic surgeon.
The procedure is an open surgery with a larger incision in the chest. The surgeon removes the abnormally formed cartilage before reshaping the sternum and placing it in its correct position. They support the repaired sternum by placing a metal strut inside the chest and attaching it to the ribs.
Over time, the cartilage will grow back and support the sternum in its new position. The surgeon then will remove the strut, usually six months to a year after the first procedure.
What are the risks and complications of pectus carinatum surgery?
Like all surgeries, pectus carinatum surgery carries risks of bleeding and infection.
More specific pectus carinatum surgery risks include:
- Chronic pain.
- Hardware malfunction.
- Overcorrection of the condition.
- Pleural effusion (a buildup of fluid between the lungs and chest wall).
- Pneumothorax (collapsed lung).
- Wound complications.
In general, the risks of surgery are low.
How long does it take to recover after surgery for pectus carinatum?
After surgery, people stay in the hospital for a few days to a week. The doctor may prescribe pain medication to help manage the pain after the procedure. Your child will also have regular follow-up visits in the weeks and months after surgery to ensure there are no complications.
Your child can return to regular activity over the course of six months:
- For the first two weeks post-surgery, they should limit mobility.
- At two to six weeks post-surgery, they can begin arm mobility.
- At six weeks to three months, they can return to regular activity, with the exception of sports and exercise.
- At three months to six months, they can return to noncontact sports like running.
- At six months, they can return to full activity, including running.
How effective is pectus carinatum treatment?
Both bracing and surgery have good results in improving the look of the chest and relieving symptoms.
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Why Choose UPMC for Pectus Carinatum Care?
UPMC provides world-class care for pectus carinatum and other chest wall conditions.
At UPMC, you'll receive:
- Comprehensive care — We offer the full spectrum of care for people of all ages, from diagnosis to management and treatment.
- Cutting-edge treatments — We offer access to the latest treatments for pectus carinatum, including the most advanced surgical techniques.
- Care from experienced clinicians — Our team has years of experience in treating pectus carinatum and other chest wall disorders.
- Individualized treatment plans — Every person is different. We'll work with you to develop a treatment plan that's best for you.
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Last reviewed by Shawn Safford, MD on 2024-11-04.
