Pectus Excavatum – Diagnosis and Treatment
Diagnosis
Doctors use several steps and tests to diagnose pectus excavatum, also called funnel chest or sunken chest.
They start with a detailed check of the chest wall. During the physical examination, the doctor looks for signs like an inward curve of the breastbone or changes in the rib cartilage.
The doctor also listens for symptoms linked to the condition. These include chest pain, shortness of breath, rapid heartbeat, dizziness, or fainting.
Certain genetic conditions, such as Marfan syndrome, Noonan syndrome, Ehlers-Danlos syndrome, osteogenesis imperfecta, or Poland syndrome, can increase the risk.
Doctors consider family history and look for links to other chest wall deformities, including pectus carinatum or scoliosis.
Key tests in diagnosis include:
| Test | What It Shows |
|---|---|
| Chest X-ray | Depth of the chest indentation, position of the heart |
| CT scan | Severity, Haller index, signs of lung/heart compression |
| MRI | Detailed view of organs and tissues |
| Electrocardiogram | Heart rhythm, abnormal electrical signals |
| Echocardiogram | Heart function, valve activity, blood flow |
| Lung function tests | Breathing capacity and airflow speed |
| Exercise function test | Heart and lung function during physical activity |
A CT scan can include the Haller index, a number that shows how pressed-in the chest is. A higher index usually means the case is more severe.
Echocardiograms and electrocardiograms help doctors find issues with heart function or rhythm, such as palpitations or irregular heartbeat.
Lung function tests measure lung capacity and can explain symptoms like wheezing, coughing, or frequent respiratory infections.
Doctors use all this information to confirm the diagnosis and determine if the pectus excavatum is mild or severe.
Treatment
Non-Surgical Methods
For children and adults with mild symptoms, non-surgical care may help. Physical therapy and special medical devices can improve the shape and function of the chest.
These approaches work best when started early, especially in younger patients whose chest walls are more flexible.
Physical Therapy Exercises:
Simple exercises can improve posture, strengthen chest muscles, and boost lung capacity. Therapists create plans to help expand the chest and correct rounded shoulders.
Key exercises include:
| Exercise Type | Main Benefit | How Often |
|---|---|---|
| Deep Breathing | Lung expansion | Daily |
| Wall Stretches | Posture improvement | Daily |
| Back Extensions | Spine support | 3–4 times/week |
| Core Strength | Better balance | 3–4 times/week |
- Deep Breathing: Expands the chest and improves lung function.
- Stretching: Loosens tight chest muscles and improves posture.
- Strength Training: Builds back, shoulder, and core muscles.
Sternal Suction Devices:
A cup-shaped device, called a vacuum bell, can help correct the chest shape in younger patients. The device uses gentle suction to pull the chest forward.
Patients usually wear it for one or more hours per day. Treatment often lasts about a year or more. Children and teenagers see the best results.
Cosmetic Options:
Some people care most about appearance. For these cases:
- Silicone Implants: A soft implant fills the sunken area for a more balanced chest.
- Dermal Fillers: Injections can temporarily improve the chest’s shape.
These cosmetic treatments do not address heart or lung problems but can help with social confidence.
Operations and Other Medical Interventions
Doctors often recommend surgery when symptoms are moderate or severe, or if the chest shape affects the heart or lungs.
Advances in surgical treatment now allow for less invasive options. This makes recovery easier for teens and adults.
Minimally Invasive Chest Correction (“Bar Placement”)
Surgeons use the Nuss procedure to correct the chest. They make a few small cuts on the sides of the chest.
Long, curved steel bars are slid under the chest bone using a thin camera for guidance.
Key Facts about Nuss-Type Procedures:
- Surgeons use one or two bars to lift the chest wall into a better position.
- The bars stay in place for two to three years.
- Recovery takes a few weeks, and most people resume light activities soon after.
- Doctors use this method for adults and kids, though some adult cases are more complex.
Pain control during and after surgery is important. Some doctors use cryoablation, which freezes certain nerves to reduce pain during recovery.
This targeted pain relief can last for weeks and helps people heal faster.
Open Chest Surgery (Traditional Correction):
Surgeons use the Ravitch technique in unusual or complex cases. They make a larger incision down the chest and remove stiff, misshapen cartilage connecting the ribs and breastbone.
Then, they use medical hardware such as a metal strut or mesh to hold the breastbone in its new position. Doctors remove these supports later, after the chest heals.
Comparison Table for Main Surgical Methods:
| Surgery Type | Main Approach | Suitability | Recovery Time | Hardware Removal |
|---|---|---|---|---|
| Nuss Procedure | Small incisions + bar | Teens, adults, children | Weeks to months | After 2–3 years |
| Ravitch Procedure | Large incision | Some adults, complex cases | Months | After 1+ years |
Other Surgical Choices:
If a patient does not want a bar or strut, or if appearance is the main concern, surgeons may offer cosmetic surgery with silicone implants or similar materials.
These options do not improve chest function but can even out the chest’s surface.
Personalized Approaches:
Doctors adjust treatment for each patient. Some centers, such as adult pectus programs, build custom care plans.
Thoracic surgeons assess the chest’s shape, symptoms, and the person’s lifestyle to suggest the best choice. Sometimes, ongoing clinical trials may offer access to newer techniques or devices.
What to Expect After Surgery:
Most people feel satisfied with how their chest looks and feels after surgery.
Those with heart or lung symptoms often report less chest pain, better exercise tolerance, and easier breathing.
Patients usually resume daily activities after a few weeks, but full recovery takes time. The surgical team guides follow-up visits, activity limits, and steps to remove any temporary bars or struts.
Common Questions about Surgical Repair:
Can adults have minimally invasive surgery?
Yes. Many adults benefit from minimally invasive techniques once used only in children.Are the bars or supports noticeable?
Patients may feel the bars, especially in the first weeks. Sometimes the bars set off metal detectors.What is the risk of recurrence?
With proper technique and care, most corrections last, but a slight risk of symptoms returning remains.
All of these methods should be discussed with a healthcare provider to balance the risks, benefits, and personal goals of each patient.
Choices depend on symptom severity, chest flexibility, age, and health needs. Organizations like Healthnile help patients understand and select the right option for their situation.
Ways to Manage and Find Support
Dealing with pectus excavatum can be challenging, especially for children and teenagers.
Talking to a mental health counselor may help boost self-confidence and reduce stress. Online forums and support groups connect young people with others facing the same condition.
Helpful tips:
- Seek professional counseling.
- Join online support communities.
- Share experiences with trusted friends or family.
Getting Ready for Your Visit
Steps You Can Take
Before the visit, it helps to stay organized.
Make a list that includes:
- Symptoms or issues your child is having, with as much detail as possible.
- Past health conditions and treatments.
- Family medical history, especially if anyone else has had pectus excavatum.
- All medicines, including vitamins and supplements.
- Questions to ask about care and possible treatments.
Having this information can make the visit smoother, especially for girls, who may have different symptoms or concerns that need to be discussed.
Questions Your Doctor Might Ask
The healthcare provider will ask about:
- When your symptoms started.
- Whether your symptoms have gotten worse.
- Any family history of chest wall problems.
Try to answer these questions clearly. This will help your doctor choose the best next steps for your care.
