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The Chest Wall Program at Lehigh Valley Reilly Children’s Hospital provides a comprehensive evaluation and treatment of disorders affecting the chest wall, including pectus excavatum, pectus carinatum and rib deformities. Early diagnosis is the key to optimizing treatment for these conditions.
What is pectus excavatum?
Pectus excavatum, also known as sunken chest or funnel chest, is a congenital chest wall deformity that occurs when an abnormal growth of cartilage within the chest wall pushes the breastbone (sternum) and ribs inward, creating a caved-in or sunken appearance.
While this condition is often present at birth, it becomes more noticeable during periods of rapid growth, such as puberty. What causes pectus excavatum is unknown, however, it has been found to run in families, and to be associated with scoliosis and connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome.
There are often no symptoms present with mild cases of pectus excavatum, however, children with moderate to severe cases may experience:
- Shortness of breath
- Fatigue
- Exercise intolerance/limitations
- Chest pain
What is pectus carinatum?
Pectus carinatum, also known as pigeon chest, is a chest wall deformity that is caused by an overgrowth of the cartilage that connects the ribs to the sternum. This condition occurs when the cartilage grows up and out, thus forcing the breastbone forward and causing the chest to have a bowed-out or pigeon-chest appearance. While some children may experience pain and tenderness in the bowed-out area of their chest, there are typically no symptoms associated with pectus carinatum outside of the chest’s appearance.
The cause of pectus carinatum is unknown, however, it has been found to run in families, which suggests genetics may play a role. It also has been associated with connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, and is present in about 20 percent of children with scoliosis.
Treatment options for pediatric chest wall disorders
The treatment of chest wall deformities is dependent upon the shape of your child’s chest and the severity of his or her condition. At Lehigh Valley Reilly Children’s Hospital, we have surgical and nonsurgical treatment options available to you. After a thorough examination, we may recommend:
- External brace therapy: Helpful for children with mild to moderate cases of pectus carinatum, a custom-made brace corrects pigeon chest by pushing the breastbone back into place. Bracing is most effective when started early – before the chest wall becomes too rigid (stiff) to respond to the brace.
- Nuss procedure: Video assisted pectus excavatum repair (VAPER), also known as the Nuss procedure, is a minimally invasive technique for surgical repair that involves placement of a concave steel bar under the sternum to correct a sunken chest.
- Ravitch procedure: Recommended when there’s twisting of the chest, abnormal cartilage growth is surgically removed, and the breastbone is returned to its normal position.
- Vacuum bell device: A nonsurgical procedure for sunken chest where a suction cup is placed on the center of the chest, which acts as a vacuum and forces the breastbone forward.
Multidisciplinary care team
Your child will receive comprehensive treatment from our multidisciplinary team, led by program director Sarah Jones Sapienza, MD, which includes the region’s leading providers of pediatric surgery, radiology, anesthesiology and pulmonology as well as orthotists and physical therapists.