Chest Wall Deformities

What are Chest Wall Deformities?

Chest wall deformities are conditions that cause physical abnormalities of the chest. The two most common types of chest wall deformities are:

Pectus Excavatum

Also known as funnel chest or sunken chest, pectus excavatum causes the chest to be depressed (turn inwards) at the sternum (breastbone). It is the most common form of chest wall deformity. Patients may be born with the condition, or it can develop later in adolescence.

Pectus Carinatum

Also known as pigeon chest or protruding chest, this condition causes the sternum and ribs to protrude. It can be caused by an excessive growth of cartilage. Pectus Carinatum can be present from birth or appear during adolescence, triggered by a growth spurt at puberty. It can also appear following surgery on the heart during which the sternum splits.

What Causes Chest Wall Deformities?

Causes of Pectus Excavatum include:

• Hereditary
• Poland Syndrome
• Marfan syndrome
• Scoliosis
• Rickets

Causes of Pectus Carinatum include:

• Present at birth
• Homocystinuria
• Trisomy 21
• Trisomy 18
• Marfan syndrome
• Multiple lentigines syndrome
• Morquio syndrome
• Osteogenesis imperfecta

How are Chest Wall Deformities Diagnosed?

Pectus Excavatum

Doctors may use computed tomography (CT) scans to see the chest’s internal structures and the degree of depression. Something called the Haller index is used to measure how severe the depression is. Pulmonary function tests and cardiac evaluations may be performed to understand how the deformity is impacting the patient.

Pectus Carinatum

The condition is usually diagnosed in young people, with a doctor performing a thorough physical examination. They may also take photographs of the chest and take measurements to monitor the condition.

How are Chest Wall Deformities Treated?

Pectus Excavatum

Surgery is required to treat a sunken chest. The preferred option is the minimally invasive Nuss procedure. It involves making small incisions under the arm pits and another to insert a very small camera. A surgeon implants metal bars underneath the sternum to elevate it. The results of the surgery are immediately felt by the patient. The bars can be removed one or two years later, when the desired bone structure is established.

The Ravitch procedure is an open surgery which involves opening the chest and removing sections of rib cartilage and then raising the sternum. The surgeon may implant struts, which are metal bars, which hold the chest wall in a normal position and reshape the chest. The struts can be removed around 6 months later.

Pectus Carinatum

A non-surgical option is a chest brace, which is custom built for each patient. The brace is worn over a period of time and reduces chest protrusion. In combination with exercise program, the therapy can completely correct the protrusion. Results are usually seen after around 6 months of treatment.

For patients with more severe pectus carinatum, surgery may be required. This involves open surgery during which sections of rib cartilage are removed and the sternum flattened. Patients notice a correction in the deformity immediately after surgery.

General Thoracic Surgery

The General Thoracic Surgery Program at Cleveland Clinic Abu Dhabi offers a range of non-surgical, surgical and minimally invasive options for the treatment of Chest Wall Deformities.

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