Pectus Carinatum

What are the signs and symptoms of pectus carinatum?

An area of the chest that is pointed outward can be easily seen during a physical exam. Children may complain of breathlessness and chest pain, particularly during exercise. They may also notice chest pain and tenderness when they lie on their stomach. Chest wall motion may be less than normal.

What tests are used to diagnose pectus carinatum?

In general, no specific testing is necessary for evaluation and treatment of pectus carinatum. The diagnosis of pectus excavatum is most commonly based on a complete physical exam of the chest. A photograph may be taken to document the shape and severity of the chest wall deformity. We may do a chest X-ray or CT exam to evaluate the severity of the deformity.

How is pectus carinatum treated?

The decision to treat may be based on the severity of the deformity or functional concerns. Your primary care provider or your surgeon may choose to only monitor a mild deformity. If treatment is needed, our chest wall treatment specialists believe in providing patients with the safest and most effective treatment methods, starting with non-surgical options such as bracing.

Bracing

Bracing is a non-invasive, non-surgical method of treatment. If your child’s chest wall has enough flexibility, they may be a good candidate for a brace. A brace will go around the chest and will apply pressure to the area of the chest that is protruding. The goal of this pressure is to flatten it out over time.

Braces are usually worn for most of the day, and therapy lasts for several months. Improvement may occur after about six months, but your child may need to wear the brace at other times thereafter if the chest protrudes out again.

Pectus carinatum surgery

Surgery may be needed for patients with more severe deformities, or for older children who have more stiff chest walls. The most commonly used surgical approach is called a modified Ravitch procedure. Your child will go to sleep with anesthesia and will not remember the procedure. The procedure includes removal or reshaping of abnormal cartilage rib segments, reshaping the sternum and inserting a removable support underneath the breastbone. Your child may have a drain or a chest tube in their chest. After the procedure, your child will stay in the hospital for several days for help with pain control and to ensure that their lungs and heart have not been affected by the procedure.

After surgery, your child will have follow-up visits with the surgeon to ensure that they are healing well and their chest is responding appropriately to the surgery.

Your child will have to limit their activity after surgery until the cartilage grows back, which takes about six months.

Why choose us for treatment of pectus carinatum?

The Department of Pediatric Surgery at Children’s Hospital Colorado is experienced in evaluating and treating pectus carinatum, both through surgery and bracing. Our hospital has specially trained staff who can provide the chest brace that is most commonly used for treatment of pectus carinatum. Our team understands how pectus carinatum can affect a child physically and psychologically. We will walk you and your child through the necessary steps of diagnosis and all your available treatment options. We will continue a relationship with your child in the following years to ensure that they respond well to management and have the best outcome possible.

Helpful resources

The American Pediatric Surgical Association works to ensure optimal pediatric surgical care of patients and their families.