What is Pectus Excavatum? Symptoms, Causes, & Treatment

Pectus excavatum is a chest wall condition where your breastbone (sternum) and ribs grow inward, creating a sunken or "caved-in" appearance in the center of your chest. This happens during development in the womb and becomes more noticeable as you grow, especially during teenage years when growth spurts occur.

You might know this condition by other names like "funnel chest" or "sunken chest." It's actually the most common chest wall deformity, affecting about 1 in 400 births. While it can look concerning, many people with pectus excavatum live completely normal, healthy lives.

What are the symptoms of pectus excavatum?

The most obvious sign is the inward curve of your chest, which can range from mild to quite deep. For many people, this visual change is the only symptom they experience, and it doesn't affect their daily activities or health.

However, some people may notice physical symptoms, especially if the indentation is more severe. Let's look at what you might experience:

• Shortness of breath during exercise or physical activity
• Chest pain or discomfort, particularly during exertion
• Heart palpitations or feeling like your heart is racing
• Fatigue that seems unusual for your activity level
• Frequent respiratory infections or feeling like you can't catch your breath
• Back pain from changes in posture as you try to hide the chest appearance

These symptoms happen because the sunken chest can sometimes press against your heart and lungs, reducing the space they have to work properly. It's worth noting that many people with even noticeable pectus excavatum don't experience any of these physical symptoms.

Beyond physical symptoms, this condition can also affect how you feel about yourself. You might feel self-conscious about your appearance, especially in situations where you'd normally remove your shirt, like swimming or sports activities.

What causes pectus excavatum?

Pectus excavatum develops when the cartilage that connects your ribs to your breastbone grows abnormally during fetal development. Think of this cartilage as the flexible connectors that hold your rib cage together - when they grow too much or in an irregular pattern, they can pull your breastbone inward.

The exact reason why this happens isn't completely understood, but genetics play a significant role. About 40% of people with pectus excavatum have a family member with the same condition or another chest wall deformity.

Several factors can contribute to developing this condition:

• Genetic mutations affecting connective tissue development
• Family history of chest wall deformities
• Certain genetic conditions like Marfan syndrome or Ehlers-Danlos syndrome
• Connective tissue disorders that affect how cartilage and bones grow

It's important to understand that pectus excavatum isn't caused by anything you or your parents did during pregnancy. It's simply how your chest developed before birth, and it often becomes more noticeable during periods of rapid growth, particularly in the teenage years.

When to see a doctor for pectus excavatum?

You should consider seeing a doctor if you're experiencing symptoms that affect your daily life or if you're concerned about the appearance of your chest. Early evaluation can help determine whether treatment might be beneficial.

Here are specific situations when medical attention is recommended:

• You experience shortness of breath during normal activities
• You have chest pain that interferes with exercise or daily tasks
• You notice your chest indentation getting deeper over time
• You feel your heart racing or skipping beats frequently
• The condition is affecting your self-esteem or quality of life
• You have family members with connective tissue disorders

For children and teenagers, it's especially important to have regular check-ups during growth spurts. The condition can worsen during these periods, and early intervention options may be more effective.

Don't hesitate to seek medical advice even if your symptoms seem mild. A healthcare provider can assess whether your pectus excavatum is affecting your heart or lung function and discuss treatment options that might help you feel more comfortable and confident.

What are the risk factors for pectus excavatum?

Several factors can increase your likelihood of developing pectus excavatum, though having these risk factors doesn't guarantee you'll develop the condition. Understanding these can help you recognize when to seek medical evaluation.

The most significant risk factors include:

• Being male - boys are 3 to 5 times more likely to develop pectus excavatum than girls
• Family history of chest wall deformities or connective tissue disorders
• Having certain genetic conditions like Marfan syndrome, Ehlers-Danlos syndrome, or Poland syndrome
• Scoliosis or other spinal curvature problems
• Mitral valve prolapse or other heart valve conditions
• Being tall and having a lean body type

Age also plays a role in how the condition presents. While pectus excavatum is present from birth, it often becomes more noticeable during adolescence when rapid growth occurs. This is why many people first become aware of their condition during their teenage years.

Having these risk factors doesn't mean you need to worry, but it does mean you should be aware of the condition and monitor any changes in your chest appearance or breathing patterns over time.

What are the possible complications of pectus excavatum?

Most people with pectus excavatum don't experience serious complications, especially when the indentation is mild to moderate. However, more severe cases can sometimes affect your heart and lung function.

Here are the complications that can occur, particularly with deeper chest indentations:

• Reduced lung capacity and difficulty breathing during exercise
• Heart compression leading to decreased cardiac output
• Exercise intolerance and early fatigue during physical activities
• Frequent respiratory infections due to decreased lung function
• Abnormal heart rhythms in rare cases
• Psychological effects including low self-esteem and social withdrawal

The psychological impact shouldn't be underestimated. Many people with noticeable pectus excavatum avoid activities like swimming, going to the beach, or playing sports where they might need to remove their shirt. This can affect social relationships and overall quality of life.

In very rare cases, severe pectus excavatum can cause significant compression of the heart and lungs, leading to serious breathing difficulties or heart problems. However, with modern diagnostic tools, doctors can identify these cases early and recommend appropriate treatment.

How is pectus excavatum diagnosed?

Diagnosing pectus excavatum usually starts with a physical examination where your doctor can see and measure the chest indentation. They'll ask about your symptoms, family history, and how the condition affects your daily activities.

Your doctor will likely perform several tests to understand how severe your condition is and whether it's affecting your heart or lung function. The evaluation process typically includes:

• Physical examination measuring the depth and width of the chest indentation
• Chest X-rays to see the bone structure and check for heart displacement
• CT scan to get detailed images and calculate the severity index
• Pulmonary function tests to measure how well your lungs work
• Echocardiogram to check if your heart function is affected
• Exercise stress testing to see how your heart and lungs respond to activity

The CT scan is particularly important because it helps doctors calculate what's called the "Haller Index" - a measurement that helps determine the severity of your condition. This index compares the width of your chest to the distance between your breastbone and spine.

These tests aren't painful, and they provide valuable information that helps your healthcare team recommend the best treatment approach for your specific situation.

What is the treatment for pectus excavatum?

Treatment for pectus excavatum depends on how severe your condition is and whether it's causing symptoms or affecting your heart and lung function. Many mild cases don't require treatment at all, while more severe cases have several effective options available.

For mild cases without symptoms, your doctor might recommend:

• Regular monitoring to watch for changes over time
• Physical therapy and exercises to improve posture and breathing
• Chest exercises to strengthen the muscles around your rib cage
• Breathing exercises to maximize lung capacity

When symptoms are present or the indentation is severe, surgical options become more relevant. The two main surgical approaches are:

The Nuss procedure involves placing a curved metal bar under your breastbone to push it outward. This minimally invasive surgery is typically done through small incisions on the sides of your chest. The bar stays in place for 2-4 years while your chest reshapes, then it's removed in a shorter procedure.

The Ravitch procedure is a more traditional open surgery where the surgeon removes the abnormal cartilage and repositions the breastbone. This approach might be recommended for older patients or those with very severe deformities.

Both surgeries have high success rates and can significantly improve both appearance and symptoms. Your surgeon will help you choose the best option based on your age, severity of the condition, and personal preferences.

How to manage pectus excavatum at home?

While home treatment can't correct the chest indentation itself, there are several things you can do to manage symptoms and feel more comfortable with your condition. These approaches work particularly well for mild cases or while you're considering other treatment options.

Breathing exercises can help maximize your lung capacity and reduce shortness of breath. Practice deep breathing techniques daily, focusing on expanding your chest and using your diaphragm fully. This can help you make the most of your available lung space.

Posture improvement is crucial because many people with pectus excavatum tend to hunch forward to hide their chest. Here are helpful strategies:

• Practice standing and sitting with your shoulders back and chest open
• Strengthen your back muscles with exercises like rows and reverse flies
• Stretch your chest muscles regularly to prevent tightness
• Consider yoga or Pilates to improve overall posture and core strength

Regular cardiovascular exercise can help improve your overall fitness and breathing capacity. Start slowly and gradually increase intensity as your tolerance improves. Swimming is particularly beneficial because it exercises both your heart and lungs while strengthening chest muscles.

Addressing the emotional aspects is equally important. Consider talking to friends, family, or a counselor about how the condition affects you. Many people find that connecting with others who have pectus excavatum through support groups or online communities helps them feel less alone.

How should you prepare for your doctor appointment?

Preparing for your appointment will help you make the most of your time with the doctor and ensure all your concerns are addressed. Start by writing down your symptoms, including when they occur and how they affect your daily activities.

Bring a list of questions you want to ask. Consider including:

• How severe is my pectus excavatum?
• Are my symptoms related to the chest indentation?
• What treatment options are available for my situation?
• Will my condition get worse over time?
• Should I avoid certain activities or exercises?
• When should I consider surgery?

Gather your medical history, including any family history of chest deformities or connective tissue disorders. If you've had previous chest X-rays or other imaging, bring copies or ensure your doctor can access them.

Consider bringing a family member or friend for support, especially if you're discussing surgical options. They can help you remember important information and ask questions you might forget.

Be prepared to discuss how the condition affects your quality of life, including any limitations in physical activities or social situations. This information helps your doctor understand the full impact of your condition and recommend appropriate treatment.

What's the key takeaway about pectus excavatum?

Pectus excavatum is a manageable condition that affects many people, and you're definitely not alone in dealing with it. While the sunken chest appearance can feel concerning, most people with this condition live full, active lives without significant health problems.

The most important thing to remember is that effective treatments are available if your condition is causing symptoms or affecting your quality of life. From simple exercises and breathing techniques to highly successful surgical procedures, there are options that can help you feel better both physically and emotionally.

Don't let pectus excavatum limit your activities or self-confidence unnecessarily. If you're experiencing symptoms or feeling self-conscious about your appearance, talking with a healthcare provider can help you understand your options and make informed decisions about treatment.

Remember that seeking help is a sign of taking good care of yourself, not a weakness. Whether you choose conservative management or decide on surgical correction, the goal is to help you feel comfortable, confident, and able to enjoy all the activities that matter to you.