Pectus excavatum
Medically Reviewed by Dr Aifric Boylan
Last updated on 17.07.2024
Pectus excavatum is a condition that causes your chest to sink in the middle over the sternum (also known as the breastbone). For this reason, it is also known as sunken, hollow, or funnel chest.
It is thought to be caused by an abnormal growth of the ribs that attach to the breastbone and it is thought to be a genetic, or inherited, condition. Approximately one-third of people with pectus excavatum have a family member with the condition. It occurs more commonly in men than women, at a rate of 4:1. It occurs in approximately 1 in 350 people.
It can be obvious and diagnosed when you are born or as an infant, but pectus excavatum becomes more pronounced in adolescence. It stays present your whole life and can get deeper over time unless it is corrected with an operation.
Symptoms and complications
It is not a painful condition but because the area inside the chest is reduced due to the funnel chest, there may be an effect on your heart and lungs. Breathing can sometimes be affected, particularly during exercise. You may also experience:
- chest pain
- reduced stamina
- an irregular heart rhythm or dizziness, if the heart is also affected.
However, the most common issue is psychological because the cosmetic appearance can lead to shame, embarrassment, anxiety and depression. People with pectus excavatum may wear baggy shirts, avoid swimming or exposing their bare chest to others for this reason.
Diagnosis of pectus excavatum
There is usually no need for any investigations to have pectus excavatum diagnosed as it is easily observed. However, your doctor may order a chest x-ray, CT scan or MRI scan to get clearer images of your chest and help measure the severity and effect on your heart and lungs.
An ECG can be done to measure your heart rate and rhythm, and an echocardiogram can be done to assess the function of the heart muscle and valves. Lung function tests can be done to assess your breathing. Some of these investigations may be necessary to do before a corrective operation.
Treatment options of pectus excavatum
Pectus excavatum does not always require treatment.
If there is minimal functional or psychological effect on you, then treatment is unnecessary.
If there is a psychological effect on you, such as avoiding swimming, always keeping a shirt on or avoiding intimate situations, then psychological therapy is useful to manage anxiety and depression.
If the psychological effect is profound or if there is also a functional effect on you, such as difficulty exercising, then surgical correction can be performed.
Surgical procedures
A surgery can be performed in two distinct ways and is best done on younger patients as their bones are still growing. However, it can also be done on adults.
- The Ravitch procedure: It has been performed since the 1940s. It involves opening the chest and moving muscle, cartilage and bone.
- The Nuss procedure: It is a less invasive operation and has become more common. It involves two to three small cuts in the chest that allow a camera and a metal bar to be inserted that can instantly lift the sunken chest. The metal bar is left in place for approximately three years, after which it can be removed and the sternum/breastbone remains elevated. Sometimes, particularly in adults, it may be left in place permanently so that the ribs do not move back to the original position.
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