Pectus Carinatum | Overview
What is pectus carinatum?
Pectus carinatum, also known as pigeon chest, is a deformity of the chest wall in which the breastbone and ribs are pushed outward. The condition occurs in about 1 out of 1,500 children and more frequently in boys. It’s often asymmetrical, with one side of the chest affected more than the other. In addition, some children have pectus carinatum on one side of the chest and an indentation called pectus excavatum on the other side of the chest.
Pectus carinatum often worsens as a child grows, particularly when the child reaches puberty. Approximately 15 percent of children with pectus carinatum develop scoliosis.
There are two basic types of pectus carinatum:
- chondrogladiolar prominence, also known as chicken breast, accounts for nearly 95 percent of cases of pectus carinatum.
- chondromanubrial prominence, also known as pouter pigeon breast, a rare type of pectus carinatum that can be more complex to treat
What are the symptoms of pectus carinatum?
The symptoms of pectus carinatum change as a child grows and matures. In infancy, symptoms can include:
- a hollow depression in the chest that may be broad and shallow, deep and narrow, or irregular
- more rapid breathing than normal
In older children, symptoms can include:
- shortness of breath upon exertion or exercise
- chest pain
- a lateral curvature of the spine
- absence of the curve of the upper back
- hooked shoulders
- a broad thin chest
What causes pectus carinatum?
There is no known cause for pectus carinatum. Some studies investigating a genetic component are underway. Although the majority of children with pigeon chest don't involve a family history of the condition, enough do to warrant suspicion that genes may play a significant role.
How we care for pectus carinatum
The Pectus and Chest Wall Treatment Program at Boston Children’s Hospital evaluates and treats infants, children and young adults using state-of-the-art operative methods to improve the quality of life for each child entrusted to our care. We base our treatment of pectus carinatum and other chest wall deformities on the severity of the condition. For mild cases of pectus carinatum, we recommend not doing anything to try to fix it. If your child’s condition is a bit more severe, we may treat them with a customized brace that gradually reshapes the chest. In rare cases, your child’s doctor may recommend surgery.
If your child develops scoliosis, the Spine Division at Boston Children’s is one of the nation’s foremost pediatric treatment and research centers.
Pectus Carinatum | Diagnosis & Treatments
How is pectus carinatum diagnosed?
Your child's doctor can diagnose pectus carinatum during a physical examination.
The physician calculates the depth of the chest from front to back using x-rays of the chest to determine if the diameter is longer than average. If it is, that means your child has pectus carinatum.
X-rays also help the doctor determine the presence of scoliosis or any other abnormalities of the bones.
Other tests your child's doctor might recommend include:
- electrocardiogram (ECG or EKG): a test that records the electrical activity of your child's heart, shows abnormal rhythms, and detects heart muscle stress
- echocardiogram (echo): a test that evaluates the structure and function of your child's heart by using sound waves recorded on an electronic sensor, which produce a moving picture of the heart and heart valves
- computed tomography (CT) scan: a test that is used to establish the level of severity of the condition and also help the surgical team plan for the procedure
How is pectus carinatum treated?
If your child has a mild case of pectus carinatum, their doctor may recommend not doing anything to treat it. For more noticeable cases, doctors typically recommend bracing. In the most severe cases, surgery may be necessary.
How does bracing work?
Bracing can treat mild to moderate cases of the condition in young children whose chests are still flexible. Once the chest bones are completely formed, bracing becomes much less effective. In this case, or if your child cannot or does not want to follow the rigorous bracing schedule, your child’s doctor may recommend a surgical procedure. A brace is made specifically for your child based on your child's measurements and the shape of the protrusion. It may need to be adjusted periodically as your child grows. The brace applies pressure to the protruding breastbone and cartilage and gradually reshapes the chest wall.
Your child will need to wear the brace at home and when sleeping at night. The process of correction will often take about a year. It's important to remember that the length of the process occurs is directly related to how long and how consistently your child wears the brace.
What is the surgical procedure to correct pectus carinatum?
Pectus carinatum can be surgically repaired in an operation called the Ravitch. In this procedure, the surgeon makes an incision in your child's chest wall, removes the cartilage wedged between the ribs and sternum, then reshapes and repositions the freed-up sternum.
A bar is left in the chest wall to maintain the correct shape for six months, during which time your child has to refrain from activities that might involve a collision, like football.