What is pectus carinatum
Pectus carinatum, also called “pigeon chest”, is a rare chest wall deformity characterized by protrusion of the sternum and the ribs. It affects around 1 in every 1500 children, occurs more often in boys and typically becomes more pronounced during early adolescence.
In pectus carinatum, the cartilages grow abnormally, causing unequal growth in the areas where the ribs connect to the sternum. This results in the outward appearance of the chest wall.
Cause and risk factors of pectus carinatum
The exact cause of pectus carinatum is not known. It is well established that the condition can run in families and genetics may be a risk factor.
Pectus carinatum occurs more frequently in people who have specific genetic conditions like Marfan syndrome, Ehlers-Danlos syndrome, Noonan syndrome, other metabolic disorders and chromosomal abnormalities.
In selected patients with suspicion of a genetic disorder further medical investigations may be indicated to rule out other significant conditions.
Symptoms of pectus carinatum
Although patients with pectus carinatum can be asymptomatic, others present with symptoms including:
- shortness of breath, especially during exercise
- anterior chest wall pain and discomfort
- tiredness and fatigue
- palpitations
Pectus Carinatum can also be associated with certain medical conditions such as:
- scoliosis
- kyphosis
- cardiopulmonary compromise
- other musculoskeletal abnormalities and connective tissue disorders such as Marfan syndrome
Diagnostic approach to pectus carinatum
A complete medical history and a careful clinical examination by an experienced doctor are necessary to assess the pectus excavatum chest wall deformity.
In addition, further investigation can be performed to rule out other clinical conditions and to decide the optimal treatment plan:
- Echocardiogram and ECG
- Lung function test
- CT scan of the chest with 3D reconstruction
Pectus carinatum – Brace treatment
Non-surgical treatment with the brace represents one of the most common and effective techniques to treat pectus carinatum.
This is accomplished by a specially fitted compression brace around the circumference of the chest that applies the correct pressure to reshape the chest and decrease the bony protrusion.
The success of bracing therapy is directly related to the elasticity of the chest wall and the number of hours per day the patient applies the brace.
We recommend to wear the brace for several hours per day and for a duration of about a year.
We will regularly, in the outpatient clinic, evaluate the progression of the treatment and adjust the bracing pressure as necessary.
We offer different type of braces for the management of the pectus carinatum including the most advanced FMF Dynamic Compressor.
This is a custom-fitted, expandable, low profile, hypoallergenic, ultra-light aluminum brace designed to deliver the precise amount of pressure needed to gradually reshape the chest wall with minimal discomfort. The system was developed in Argentina and is being used worldwide.
The major advantage of this bracing system is that it objectively measures the pressure needed to correct the condition.
Bracing treatment for pectus carinatum is very safe.
Pectus Carinatum –Surgery
Surgery for pectus carinatum is an option for patients that have reached adulthood and there is no chest elasticity, making the brace treatment is ineffective.
The modified Ravitch procedure is a surgical operation that involves removing the abnormal cartilages and placing the breastbone in a normal position within the chest. The procedure is performed with general anaesthesia through a vertical midline incision just on top of the deformity. In some cases, the surgeon will need to break the breastbone so that they can reposition it accurately most of the times using a metal plate. The result following the procedure is usually very good and following a hospital stay of 4-5 days the patient can be discharged home.