Pectus excavatum: symptoms, causes, to treatment

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Definition

What is pectus excavatum?

Pectus excavatum (sunken chest) is a condition that causes a crushed sternum (sternum) to enter the chest. In severe cases, it can look as if the center of the chest is missing and causes a dent.

The concave sternum is usually seen some time after birth, but the severity of the pectus excavatum increases as the child grows as a teenager. This condition occurs in 1 in thousand children.

Also known as funnel chest, pectus excavatum is more common in boys than girls. In severe cases, this condition can eventually interfere with the function of the heart and lungs.

Children usually feel insecure about this condition because of their appearance. Surgery can be used to correct the deformity.

Symptoms

What are the signs and symptoms of pectus excavatum?

In most people with this condition, the only sign or symptom that is experienced is a curvature of the chest. In some people, the curve deepens as they reach adolescence into adulthood.

In severe cases, the sternum may put pressure on the heart and lungs, causing the following physical symptoms:

• Tired easily when exercising
• Fast or pounding heartbeat (palpitations)
• Recurrent respiratory infections
• Coughing or wheezing
• Chest pain
• Heart murmur
• Fatigue

Meanwhile, psychologically, the symptoms of this condition are:

• Very ashamed of appearance, especially the chest
• Confidence problems
• Clinical depression

There may be signs and symptoms not listed above. If you have concerns about a particular symptom, consult your doctor.

Cause

What causes pectus excavatum?

The cause of pectus excavatum is not known for sure, but it could be due to a genetic condition. Most cases of this condition are reported to run in families.

Risk factors

What increases my risk for pectus excavatum?

Pectus excavatum is more common in boys than girls. In addition, other risk factors for pectus excavatum are:

• Marfan's Syndrome. A disorder that causes connective tissue problems in the body.

• Ehlers Danlos Syndrome. Ehlers Danlos syndrome is a rare disease that affects the connective tissue in the body, especially the skin, joints, and blood vessel walls.

• Osteogenesis imperfecta. Osteogenesis imperfecta (OI) or brittle bone disease is a condition in which bone formation is not formed properly.

• Noonan Syndrome. This condition is a birth defect caused by a genetic disorder with a variety of symptoms, including heart defects.

• Turner Syndrome. Turner syndrome is a genetic disorder related to chromosomal defects.

• Poland Syndrome. This syndrome is a rare birth defect characterized by missing or underdeveloped muscles on one side of the body, particularly in the chest muscles.

• Rickets. Rickets is a disorder caused by a deficiency of vitamin D, calcium or phosphate resulting in softening and weakening of the bones.
• Scoliosis. Scoliosis occurs when the spine curves incorrectly.

Complications

What complications might occur with this condition?

A severe condition of pectus excavatum can compress the heart and lungs or press the heart to the other side. In mild cases, this condition can cause self-image problems. Quoted from the Mayo Clinic, complications that may occur due to pectus excavatum are:

Heart and lung problems

If the depth of the sternum indentation is severe, the lungs will lack room to expand. This pressure may squeeze the heart and push it to the left of the chest. This condition also decreases the heart's ability to pump efficiently.

Self-image problems

Children with pectus excavatum tend to have a forward hunched posture, with the ribs and shoulder blades widened. Many of them avoid activities such as swimming because they cannot hide their physical condition.

Diagnosis

How is this condition diagnosed?

Usually, a sunken chest is diagnosed by a simple examination of the chest. However, the doctor may order several types of tests to find problems related to the heart and lungs. Examinations that may be done to diagnose pectus excavatum are:

Chest X-ray

This examination can make a delineation of the sternum and show the position of the heart in the chest. X-rays are painless and only last a few minutes.

Computerized tomography (CT)

A CT scan may be useful to determine the severity of the pectus excavatum and whether the heart or lungs are compressed. A CT scan captures X-ray images from multiple sides to produce structures from all sides

Electrocardiogram

An electrocardiogram can show whether the heart rhythm is normal or unusual, and whether the electrical signals that control the heart rate are timed correctly.

Echocardiogram

This procedure is a sonogram of the heart. An echocardiogram can show real-time pictures of the heart and its valves in action.

Lung function tests

Pulmonary function tests aim to measure the amount of air your lungs can hold and how quickly you can empty your lungs again.

Checks during exercise

This check monitors your heart and lung function during exercise, generally while cycling and walking on a treadmill.

Treatment

How is pectus excavatum treated?

If the sternum problem is not causing significant physical and mental complaints, you do not need specific treatment. However, you may need psychological therapy to deal with insecurities.

In moderate to severe conditions, surgery may be recommended to correct the condition of the pectus excavatum. When this pressure on the breastbone interferes with lung function or causes serious problems, your doctor may recommend surgery to correct the position of the bones.

This procedure is usually recommended when the sternum presses on the lungs making it difficult for you to breathe. Here are the two most common types of surgery to correct the condition of pectus excavatum:

• Smaller incision

For a minimally invasive procedure, small incisions are placed on both sides of the chest, under each arm. Fiber optic instruments and cameras are inserted through the incisions. A curved metal rod threaded under the compressed sternum, to raise it to its normal position. In some cases, doctors use more than one stick which will be removed after two to three years.

• Larger incision

An incision in the middle of the chest allows the surgeon to clearly see the sternum directly. The deformed cartilage binding the ribs to the sternum is removed and the sternum is fixed to its normal position with a surgical instrument, such as a metal brace or a mesh brace. These tools will be removed after six to 12 months.

Most people who go through surgery to repair the pectus excavatum are satisfied with the appearance of their chest, no matter what type of procedure. Maximum results will be realized when the operation is performed at puberty, but similar results can also be felt in adults.