Pectus Carinatum Symptoms, Causes & Treatment Options

Pectus carinatum is a deformity of the chest in which the front of the chest protrudes forward. It is believed to be caused by factors including abnormal growth.

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. Questions Your Doctor May Ask
  7. References

What Is Pectus Carinatum?

Summary

Pectus carinatum is a deformity of the chest in which the front of the chest protrudes forward. It is believed to be caused by factors including abnormal growth and/or composition of cartilage and bones in the chest, as well as genetic conditions that cause abnormal bone and muscle development.

The primary symptom is a forward protrusion of the chest. Uncommonly, pectus carinatum may cause pain when pushing on the anterior chest or difficulty breathing. It can also cause a disturbed body image and reduced quality of life.

The diagnosis is made by physical exam and imaging to determine the severity of the deformity. Treatment options include wearing a brace to compress the chest and surgery to fix the deformity.

Recommended care

You should contact your primary care physician to discuss if there are another other symptoms present. Otherwise no treatment is indicated for this condition.

Pectus Carinatum Symptoms

The main symptom of pectus carinatum is the protrusion of the chest. This may be seen in childhood but is usually not noticed until adolescence, when the protrusion becomes more prominent. Other chest-related symptoms may occur, as well as other bone, muscle, and psychological symptoms.

Chest protrusion details

This protrusion will not go away on its own but will usually stop growing after adolescence. This protrusion appears different in the two main types of pectus carinatum:

  • Protrusion of the middle and lower parts of the chest plate: This more common type is also known as "chicken breast" or "keel chest." This type accounts for about 95 percent of cases [1].
  • Protrusion of the upper and lower parts of the chest plate: This less common type is also known as "pigeon breast." The forward protrusion of the upper and lower parts of the chest and the backward protrusion of the middle part causes the chest to look like a "Z" shape from the side.

Other chest-related symptoms

Other chest-related symptoms may be present in some people with pectus carinatum, including:

  • Pain when pushing on the anterior chest: In some people, pushing on the front of the chest can cause mild pain. However, the deformity is painless is most people.
  • Difficulty breathing: By itself, pectus carinatum usually does not cause any symptoms involving the lungs such as trouble breathing. However, difficulty breathing was reported in one case series of 260 patients undergoing surgery for pectus carinatum [2].

Bone and muscle symptoms

Some people with pectus carinatum can have other associated bone and muscle abnormalities, such as:

  • An abnormally curving backbone: This is the most common finding with pectus carinatum.
  • Marfan syndrome: This condition is sometimes associated with pectus carinatum, and can cause long bones, flexible joints, stretchy skin, abnormal facial structure, blurry vision, chest pain or discomfort, or trouble breathing [3].

Psychological symptoms

Some people with pectus carinatum, especially children, may experience psychological symptoms, such as:

  • A disturbed body image: This is due to the appearance of the chest or other areas of the body.
  • A reduced quality of life: Negative feelings may cause individuals to avoid activities such as changing or swimming around others.

Pectus Carinatum Causes

Pectus carinatum is the second most common chest wall deformity in children [1]. The specific cause of pectus carinatum is not known, but it is found more often in boys and in children whose family members also have pectus carinatum. Possible causes include:

  • Abnormal cartilage growth: Cartilage is the material in our bodies that goes on to develop into bone. In excess in the chest, it can lead to pectus carinatum.
  • Changes in cartilage composition: If cartilage in the chest changes in biochemical material composition, this can lead to pectus carinatum.
  • Abnormal growth of the bones: This includes the chest plate and the ribs, which could also contribute to pectus carinatum.
  • Genetic conditions: Approximately one-fourth of children with pectus carinatum have a family history of the condition [1]. This suggests that there may be underlying genetic changes that cause pectus carinatum. The most common associated finding is an abnormal curvature of the back bone, suggesting a link to other genetic conditions that causeabnormal bone and muscle development.

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Treatment Options and Prevention for Pectus Carinatum

Pectus carinatum is a long-term condition that will not go away on its own. By itself, pectus carinatum is not dangerous. It does not cause any symptoms other than the abnormal appearance of the chest, and having it will not make you sick or shorten your lifespan. Therefore, treatment with a compression brace or surgery is optional and can be done when the appearance becomes concerning enough for you.

Compression brace

If you have mild pectus carinatum or flexible bones, your physician may recommend you wear a brace to correct the protrusion.

  • Details: The brace is a stiff device worn around the chest to compress the protrusion and slowly restore the normal shape of the chest over time. The brace is usually worn for a number of hours every day for at least six months. The time that you need to wear the brace will depend on how flexible your chest is and how severe your protrusion is.
  • Prognosis: Wearing a brace can result in good outcomes in about 75 to 90 percent of cases [4,5].
  • Side effects: It is associated with few side effects compared to undergoing surgery.

Surgery

If you have severe pectus carinatum or your bones have already hardened, your physician may recommend surgery to correct the deformity.

  • Details: Surgery is usually done around 13 to 16 years of age, when the deformity has mostly stopped changing but the bones are still immature enough to correct. Surgery can be completed in adults as well.
  • Prognosis: Surgery is usually most successful in children, however, surgery has been successfully done in people up to 49 years old [1].
  • Side effects: Surgery usually results in good outcomes in most people, but can cause side effects in some people such as trouble breathing or frequent lung infections.

Prognosis

Again, pectus carinatum does not require treatment on its own unless it is causing other conditions. However, corrective treatment of pectus carinatum not related to other conditions results in good or excellent outcomes in 90 percent of cases [6].

When to Seek Further Consultation for Pectus Carinatum

You should seek medical attention if you notice concerning symptoms associated with pectus carinatum.

If you notice a protrusion of your chest that is concerning to you

Your physician can evaluate if the protrusion is due to pectus carinatum and evaluate you for any associated conditions, as well as offer you treatment options. Pectus carinatum by itself does not need to be treated for medical reasons, so it is entirely your choice if you want to have it treated for appearance reasons. However, it is a good idea to have your physician do a complete evaluation to make sure you do not have any associated conditions that require treatment.

If you notice you have a curved backbone as well as a protrusion of your chest

You should go see your physician on a regular basis. Your physician can monitor the severity of the curvature of your backbone, and possibly recommend treatment options if the curvature becomes too severe.

If you experience blurry vision, chest pain or discomfort, or trouble breathing

You should go see your physician if you notice these symptoms in addition to having a protrusion of your chest. These symptoms might suggest that you have another condition associated with pectus carinatum, in which case your physician can perform a full evaluation and order tests to see if you require any treatment.

Questions Your Doctor May Ask to Determine Pectus Carinatum

To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.

  • Do you currently smoke?
  • Where is your chest pain exactly?
  • What is your body mass?
  • Are your symptoms worse during the late afternoon or night?
  • Have you lost your appetite recently?

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References

  1. Desmarais TJ, Keller MS. Pectus carinatum. Curr Opin Pediatr. 2013; 25(3):375-81. doi: 10.1097/MOP.0b013e3283604088. PubMed Link
  2. Fonkalsrud EW. Surgical correction of pectus carinatum: lessons learned from 260 patients. J Pediatr Surg. 2008;43(7):1235-43. JPS Link
  3. Cobben JM, Oostra RJ, van FS. Pectus excavatum and carinatum. Eur J Med Genet. 2014;57(8):414-7. EJMG Link
  4. Banever GT, Konefal SH, Gettens K, Moriarty KP. Nonoperative correction of pectus carinatum with orthotic bracing. J Laparoendosc Adv Surg Tech A. 2006;16(2):164-7. JLAST Link
  5. Frey AS, Garcia VF, Brown RL, et al. Nonoperative management of pectus carinatum. J Pediatr Surg. 2006;41(1):40-5. PubMed Link
  6. Williams AM, Crabbe DC. Pectus deformities of the anterior chest wall. Paediatr Respir Rev. 2003;4(3):237-42. PRR Link