Pectus excavatum, or sunken chest, is a thoracic deformity that affects about 1 in 500 Portuguese people, being 4 times more common in males. Often, it resolves spontaneously, but surgery may also be necessary. Discover exactly what it is, its causes, and how to treat it.
What is pectus excavatum?
Pectus excavatum, commonly known as a sunken chest, occurs when the rib cartilage grows more than expected and, having nowhere to go, pushes the sternum inward. As a result, it causes a deformity in the chest, which can be symmetrical or asymmetrical and either mild or severe.
In most cases, pectus excavatum is diagnosed at birth, and the progression can vary. On the one hand, it may resolve spontaneously with growth, but improvements naturally occurring after the age of 6 are rare. Pectus excavatum can compress thoracic organs, increasing the risk of respiratory infections. Furthermore, it negatively affects patients' behavior, especially in adolescents. They tend to feel diminished and avoid showing their chest, especially at the beach, swimming pools, and other contexts involving more body exposure.
What are the main causes of pectus excavatum?
The exact cause of pectus excavatum is unknown, but it is considered a combination of genetic and environmental factors. There is a genetic predisposition, as about 35% of cases have family members with the same deformity.
Additionally, it may occur in association with other conditions such as congenital heart disease, scoliosis, or congenital diaphragmatic hernia. In these situations, thoracic deformity is part of a broader set of clinical features. However, pectus excavatum can occur without an obvious cause.
What are the symptons?
Symptoms associated with pectus excavatum can vary considerably. In mild cases, symptoms may be minimal or absent, while more severe cases can even cause serious complications. The most common symptoms include:
1. Body configuration
Aesthetically, pectus excavatum manifests as a depression in the center of the chest. Even when it does not cause functional problems, it is a source of anxiety for some patients.
2. Respiratory symptoms
Respiratory symptoms are common in some people with pectus excavatum. They may experience breathing difficulties, especially during physical activities, shortness of breath, and rapid breathing. In more severe cases, cardiovascular symptoms such as chest pain and heart palpitations may occur.
3. Functional compromise
Pectus excavatum can significantly compromise daily activities. Some patients report excessive fatigue during physical exercise and reduced physical endurance. Gastrointestinal disturbances, such as gastroesophageal reflux and abdominal discomfort associated with organ compression, may also occur.
4. Postural changes
It is common for postural changes to develop as a way to compensate for the chest deformity. For example, patients often tend to hunch their shoulders forward to visually level the chest area. They may also lean forward, especially when standing, to reduce the visibility of the chest depression. Additionally, they may rotate the hips to compensate for the asymmetry created by the thoracic deformity.
All these postural changes may not be conscious and generally cause musculoskeletal discomfort. Back or neck pain is common due to the automatic and continuous effort to maintain a compensatory posture.
How is pectus excavatum diagnosed?
The diagnosis of pectus excavatum can be made by the neonatologist after birth, or by the pediatrician or orthopedist throughout life. Initially, it is made by direct observation of the chest. The doctor will assess the presence of symptoms such as difficulty breathing, chest pain, or changes in posture.
Additionally, imaging tests may be necessary to observe the chest bone structure in detail, confirm the diagnosis, and evaluate the extent of the deformity. Cardiological evaluation is also important to screen for any associated anomalies.
What does treatment consist of?
The treatment of pectus excavatum can vary depending on the severity of symptoms, the patient's age, and other individual factors. Since it is a benign condition, treatment may not be necessary, especially if it is not causing significant symptoms. However, when aesthetic or functional factors are more pronounced, medical intervention may be necessary. The most common treatment options include:
1. Physiotherapy and exercises
Specific exercises and physiotherapy may be recommended to improve posture, respiratory function, and muscle strength. These therapeutic approaches can be especially useful in milder cases.
2. Orthoses and compression devices
In some cases, devices such as braces or orthoses may be prescribed to try to reconfigure the thoracic wall. However, the effectiveness of these methods varies and depends on the patient's age and the severity of the deformity.
3. Vaccum bell
The vacuum bell is a non-surgical device that integrates conservative treatment for pectus excavatum, mainly in children. It is a silicone cup placed over the chest depression and creates a vacuum when connected to a suction system. The goal is to apply negative pressure to the area, gradually lifting the sternum and reconfiguring the thoracic wall over time. Typically, this approach also involves combining it with a physical exercise plan.
4. Surgery
In more severe cases and when the disease is particularly disabling, surgical correction may be considered. The most common procedure is the Nuss procedure, a minimally invasive technique involving the insertion of metal bars under the sternum to reconfigure the thoracic wall. The doctor may also advise other surgical approaches, such as the removal of the cartilage that connects the ribs to the sternum and realignment of the bones.
How to prevent?
Since the causes of pectus excavatum are unknown, there are no specific preventive measures to avoid the development of this deformity.
However, it is important to adopt some general practices that promote musculoskeletal system health and overall physical development.
- Receive adequate prenatal care during pregnancy.
- Maintain good posture throughout life.
- Exercise regularly.
- Keep up with medical check-ups.
Other thoracic deformities: pectus carinatum or pigeon chest
In addition to pectus excavatum, there is another thoracic deformity called pectus carinatum (or pigeon chest). In this case, the sternum protrudes outward, unlike pectus excavatum, which is concave. The central part of the chest appears more elevated than normal, resembling a bird's chest.
This deformity also develops during childhood and adolescence when the cartilages near the sternum grow excessively, causing the projection forward. In the case of children and adolescents, simply using a specific brace on the thoracic wall, whose pressure causes the protrusion to regress, may be sufficient. In more severe cases, a surgical procedure may be necessary to correct the protruding area of the chest. In either case, treatment is effective and definitive.
Joaquim Chaves Saúde, first-line treatment for pectus excavatum
Joaquim Chaves Saúde provides a range of solutions to treat pectus excavatum and other thoracic deformities minimally invasively and definitively. The patient is evaluated by various clinical specialties to define a therapeutic plan suitable for each case. Schedule your appointment now and regain your quality of life.