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Pectus Excavatum and Carinatum

Pectus excavatum and carinatum are when the chest wall goes in or projects out too much. It is a congenital (from birth) condition that usually appears during puberty.

With pectus excavatum, the center part of the sternum or the breastbone is pushed backward by several centimeters, causing a "sunken chest." With pectus carinatum, the sternum projects too far forward. This is sometimes called a "pigeon chest."

What happens once you have pectus excavatum and carinatum?

The biggest symptom of these conditions is the chest appearance. In teenagers, this becomes more noticeable because they're still growing.

They may start to have these symptoms:

  • Fatigue.
  • Chest pain.
  • Decreased stamina.
  • Shortness of breath.

People with pectus excavatum may find that they need to take frequent breaks when they're playing sports. This is because the chest wall is compressed by the indentation. This cardiac compression may also restrict pulmonary blood flow. This creates fatigue and shortness of breath.

If you have one of these conditions and are not having symptoms, nothing needs to be done. Many people live their lives with pectus excavatum and carinatum with no health problems. If you don't like the way it looks, you can have reconstructive surgery.

What causes pectus excavatum and carinatum?

The reason for this congenital condition is unknown. The ribs and cartilage grow too much and push the sternum inward or outward.

What types of tests are used to diagnose pectus excavatum and carinatum?

The doctor will ask you about your medical history and perform a physical examination. The main test is a chest X-ray from the front and side.

In certain cases, the doctor may prescribe any of these tests:

  • Computerized tomography (CT): A CT scan can help determine whether there is any heart and lungs compression.

  • Electrocardiogram: An electrocardiogram can show the rhythm of the heart and if there is a problem with the heart's electrical activity.

  • Echocardiogram: An echocardiogram can show real-time images of how well the heart and its valves are working.

  • Exercise test: This test monitors your heart and lung function while you exercise, usually on a bike or treadmill.

  • Lung function tests: These tests measure your lung capacity, the maximum amount of air you can exhale after fully inhaling.

What types of treatments and procedures are used to treat pectus excavatum and carinatum?

Pectus excavatum and carinatum can be surgically repaired. This is usually for people with severe signs and symptoms. Physical therapy can help people with mild signs and symptoms. Certain exercises can improve posture and chest expansion.

If you don't have symptoms but don't like how your chest looks, you can talk to a surgeon about having silicone inserted into the space.

The two most common surgical procedures are:

  • Nuss procedure: The surgeon makes small incisions on the sides of your chest. A curved metal bar is threaded under the breastbone to lift it to a normal position. It is minimally invasive.

  • Ravitch technique: A surgeon makes an incision down the center of your chest. The surgeon removes the deformed cartilage attaching the ribs to the lower breastbone and positions the breastbone into a more normal position.

What can I do to support my health when I have pectus excavatum and carinatum?

If you have had reconstructive surgery, your post-surgical care involves visits with the pediatric surgeon two to three weeks after surgery and at regular intervals for the next two years.

If you are doing physical therapy, you should continue to work with your physical therapist as prescribed.

If you are monitoring your condition, visit your pediatrician when you notice the indent or projection of your chest is getting larger or if you start to feel symptoms.

Why choose Presbyterian for pectus excavatum and carinatum treatment?

Presbyterian Heart and Vascular Care has a team of highly-skilled surgeons who are using some of the most trusted and advanced surgical techniques. Their surgical team can help you decide what treatment is best for you and help you prepare for your procedure.