Pectus excavatum: Overview, symptoms, treatments, and more Health ConditionsHealth ConditionsAlzheimer's & DementiaAnxietyArthritisAsthma & AllergiesBreast CancerCancerCardiovascular HealthCOVID-19Dermatology & SkincareDiabetesEnvironment & SustainabilityExercise & FitnessEye HealthHeadache & MigraineHealth EquityHIV & AIDSHuman BiologyInflammatory Bowel DiseaseLeukemiaLGBTQIA+Men's HealthMental HealthMultiple Sclerosis (MS)NutritionParkinson's DiseasePsoriasisSexual HealthWomen's HealthDiscoverNewsLatest NewsOriginal SeriesMedical MythsHonest NutritionThrough My EyesNew Normal HealthPodcastsHow to understand chronic painWhat is behind vaccine hesitancy?The amazing story of hepatitis C, from discovery to cureNew directions in dementia researchCan psychedelics rewire a depressed, anxious brain?Why climate change matters for human healthToolsGeneral HealthDrugs A-ZHealth HubsHealth ToolsBMI Calculators and ChartsBlood Pressure Chart: Ranges and GuideBreast Cancer: Self-Examination GuideSleep CalculatorHealth ProductsAffordable Therapy OptionsBlood Pressure MonitorsDiabetic SuppliesFitness TrackersHome GymsGreen Cleaning ProductsHow to Shop for CBDQuizzesRA Myths vs FactsType 2 Diabetes: Managing Blood SugarAnkylosing Spondylitis Pain: Fact or FictionConnectAbout Medical News TodayWho We AreOur Editorial ProcessContent IntegrityConscious LanguageNewslettersSign UpFollow UsMedical News TodayHealth ConditionsDiscoverToolsConnectSubscribe What is pectus excavatum Symptoms treatments and moreMedically reviewed by Mia Armstrong, MD — By Oladimeji Ewumi on June 29, 2022Pectus excavatum is a developmental issue with the chest in which the sternum or breastbone caves inward and creates a sunken appearance. It is also known as cobbler’s chest or funnel chest. Pectus excavatum is the most common congenital anomaly of the chest wall in children. It may become evident at birth or later in life as a person grows into adolescence. This article looks at the symptoms, causes, and risk factors of pectus excavatum, as well as diagnosis, treatment options, and outlook. What is pectus excavatum Share on PinterestScience Photo Library – IAN HOOTON/Getty ImagesPectus excavatum is an anomaly of the chest wall in which the breastbone grows inward during the embryologic phase of development. Usually, as the chest wall grows around the 35th day of gestation, the cartilage that connects the ribs flattens out so the ribs can easily fuse with the breastbone. In people with pectus excavatum, the breastbone fails to fuse normally and presses inwards. This causes a sunken appearance at the point where the ribs connect to the breastbone. The condition may be more prominent on one or both sides of the chest. According to a 2016 article, pectus excavatum accounts for 90% of all chest wall abnormalities and affects 1 in 300–400 live births. Symptoms of pectus excavatum Pectus excavatum is a progressive condition that can worsen with age. A distinctive feature of pectus excavatum is a depression of the chest. This can make a person have slouched, forward-facing shoulders. Other physical features may include a curved spine, flared ribs, and a protruding abdomen. A doctor will perform a physical examination of the chest to see if it pushes inward. A person with pectus excavatum may have other symptoms, such as:asthmachest paintirednessdyspnea, or shortness of breathproblems tolerating exerciseabnormal heart rhythms, or arrhythmiafast heart rate, or tachycardiaheart palpitationsrespiratory infectionspoor posture Cases of pectus excavatum can range from mild and asymptomatic to severe. Mild cases may be hard to notice, showing little or no symptoms. Severe cases may cause a hollow depression in the chest wall. In a mild case of pectus excavatum, a child can live their life without the condition affecting day-to-day activities. However, if complications from pectus excavatum impair cardiac or breathing functions, a doctor may recommend surgery to ease distress and improve quality of life. Health experts recommend that people with mild pectus excavatum still contact a doctor for clinical assessment and diagnosis, noting that even a flat, wide chest can compress the heart. What causes pectus excavatum Healthcare professionals do not know what exactly causes the condition. However, they believe it happens when the ribs and cartilage grow abnormally, resulting in the posterior displacement of the breastbone. This condition occurs during the developmental phase of an embryo. Risk factors for pectus excavatum While doctors do not know the main cause of pectus excavatum, they have identified some factors that can heighten a person’s risk of the condition.Sex: Male infants are up to five times more likely to develop pectus excavatum than females. However, a study in the Journal of Osteopathic Medicine notes that doctors may miss the condition in people assigned female at birth due to breast tissue disguising it.Family history: Roughly 43% of people with pectus excavatum have a family history of the condition, but scientists have not been able to detect the specific gene responsible. Diagnosis A doctor can recommend a combination of any of the following tests to make a diagnosis: Thoracic imaging Thoracic imaging, such as an X-ray, CT scan, or MRI scan, can help a doctor calculate the Haller index. The Haller index is a standardized measurement to estimate the severity of curvature of the chest cage. Healthcare professionals calculate it by dividing the chest width by the distance between the breastbone and spine. A Haller index score of 2.5 to 2.7 is considered standard, while an index of 3.25 or greater is severe. EKG An electrocardiogram (EKG) records the heart’s electrical activity. People with pectus excavatum may have an abnormal heart rhythm, which would appear on an ECG. Echocardiography An echocardiogram detects abnormalities in the heart structure using ultrasound. The echo evaluates the function or movement of the heart vessels and valves and can detect abnormalities in those with pectus excavatum. Blood analysis People with pectus excavatum may have elevated levels of lactate dehydrogenase (LDH) in their blood. This increase may be due to internal organ compression. However, elevated LDH levels can occur with other conditions, so a doctor will need more information to diagnose pectus excavatum. Pulmonary function test It is common for people with pectus excavatum to experience restrictive lung function. This is when the lungs cannot hold as much air. Older adults with pectus excavatum may also have obstructive lung disease, which is when something blocks the airways. Either of these issues will show up on a pulmonary function test. Complications of pectus excavatum The following complications are usually associated with pectus excavatum:Heart problems: Pectus excavatum can cause the breastbone and surrounding bony structures to move inward, pushing the heart further to the left side of the chest. This displacement can compress the underlying right side of the heart, leading to right ventricular dysfunction.Breathing problems: Pectus excavatum can exert pressure on the lungs, causing shortness of breath.Problems with self-image: Because the condition can affect a person’s appearance and posture, some people may find that pectus excavatum causes low self-esteem and problems with self-image. However, a 2018 study found that body image and self-esteem improved significantly in pectus excavatum patients after surgery. Associated conditions Some children with pectus excavatum can have other underlying medical conditions. Examples include:congenital scoliosisMarfan syndromeNoonan syndromePoland syndromeEhlers-Danlos syndromearterial tortuosity syndromehomocystinuriamyotonic dystrophytype 1 neurofibromatosisfetal alcohol syndromeosteogenesis imperfecta Treatments A doctor will evaluate a person’s physical appearance and symptoms to determine the severity of the condition and choose the most suitable treatment option. A doctor may recommend surgery if a person’s symptoms are causing cosmetic concerns related to appearance or other health complications that affect daily life. Research from 2016 suggests that a person may be eligible for surgery if they meet any two of the following criteria:a Haller index score greater than 3.25severe and progressive deformity with associated symptomscardiology tests showing cardiac compression or displacement affecting heart functionpulmonary function tests showing restrictive or obstructive breathingprevious failed pectus excavatum repair surgery A pediatric or cardiothoracic surgeon — a doctor specializing in operating on the heart, lungs, and other structures in the thoracic cavity — can perform this surgery. Doctors usually wait until a child has crossed their first major pediatric growth spurt. This is generally between the ages of 10–15 years when a child reaches mid-adolescence. Additional evidence suggests that adults can have a successful pectus repair surgery too. Surgery can be minimally invasive or extensive and may include the following procedures. The Nuss procedure This procedure is minimally invasive and is usually the first line of surgical intervention. A surgeon will make two small incisions just below the nipples and a third one to guide the insertion of the concave metal bar with the aid of a tiny camera. The surgeon will place the bar directly behind the breastbone at the point of depression so that the metal bar elevates and supports it. The doctor may remove the metal bar after 2–3 years once the chest has achieved its desired shape. It is suitable for children and adolescents. The Ravitch procedure The Ravitch procedure is a more invasive procedure in which a surgeon makes a horizontal incision to open the chest cavity and reposition the breastbone. The surgeon will then use tiny screws and a metal plate to hold the breastbone to attain an optimal position. It is suitable for older adults and people with asymmetric deformities. What are the benefits and risks of surgery Pectus repair surgery can benefit people with mild to severe pectus excavatum by improving self-esteem and cardiopulmonary function. Both surgical procedures are safe and offer high patient satisfaction rates. The risks of pectus repair surgery may include:paininfectionbleedingcardiac lacerationshifting of the metal barpneumothorax, or a collapsed lungpleural effusion, or fluid around the lungsan unsatisfactory result Outlook for people with pectus excavatum Researchers have not found clear evidence that pectus excavatum affects life expectancy. However, the British Lung Foundation notes that most children with the condition live their everyday life. Surgery can improve the quality of life of people with severe symptoms, self-image concerns, or both. Summary Pectus excavatum is a congenital anomaly affecting the chest wall. It makes the breastbone push in rather than assume a flat position. While some children with the condition may be asymptomatic, others may experience discomforting shortness of breath, chest pain, and self-esteem problems. A doctor will evaluate a person’s condition and decide if surgery is the best option. People who undergo pectus repair surgery have an excellent outlook because surgery can correct the condition and improve posture. Last medically reviewed on June 29, 2022SurgeryPediatrics / Children's Health 12 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Abdullah, F., et al. (2016). Pectus excavatum: More than a matter of aesthetics [Abstract].https://journals.healio.com/doi/10.3928/19382359-20161007-01Hebra, A., et al. (2016). Minimally invasive repair of pectus excavatum.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5637818/Irfaan, A., et al. (2017). Pectus excavatum: A review of diagnosis and current treatment options.https://www.degruyter.com/document/doi/10.7556/jaoa.2017.021/htmlJaroszewski, D. E., et al. (2016). Success of minimally invasive pectus excavatum procedures (modified Nuss) in adult patients (≥30 years).https://www.annalsthoracicsurgery.org/article/S0003-4975(16)30250-8/fulltextKanagaratnam, A., et al. (2016). Ravitch vs. Nuss procedure: Systematic review and meta-analysis.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5056933/Lo, P. C., et al. (2020). The Nuss procedure for pectus excavatum: An effective and safe approach using bilateral thoracoscopy and a selective approach to use multiple bars in 296 adolescent and adult patients.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7259695/Nuss, D., et al. (2016). Pectus excavatum from a pediatric surgeon's perspective.https://pubmed.ncbi.nlm.nih.gov/27747183/Pectus excavatum (2019).https://www.blf.org.uk/support-for-you/funnel-chestSharma G., et al. (2021). Pectus excavatum.https://www.ncbi.nlm.nih.gov/books/NBK430918/Sujka, J. A., et al. (2018). Quantification of pectus excavatum: Anatomic indices.https://pubmed.ncbi.nlm.nih.gov/30078482/Zaki, A. L., et al. (2021). Modified Ravitch procedure for pectus excavatum combined with complex cardiac surgery.https://www.semthorcardiovascsurg.com/article/S1043-0679(21)00108-8/fulltextZuidema, W. P., et al. (2018). Early consequences of pectus excavatum surgery on self-esteem and general quality of life.https://pubmed.ncbi.nlm.nih.gov/29411068/FEEDBACK:Medically reviewed by Mia Armstrong, MD — By Oladimeji Ewumi on June 29, 2022 Latest newsWhat sets 'SuperAgers' apart? Their unusually large neuronsOmega-3 may provide a brain boost for people in midlifeSeasonal affective disorder (SAD): How to beat it this fall and winterCDC: Monkeypox in the US 'unlikely to be eliminated in the near future'Why are more women prone to Alzheimer's? New clues arise Related CoverageWhat is pectus carinatum and can it be treated?Medically reviewed by Deborah Weatherspoon, Ph.D., MSN Learn all about pectus carinatum, also known as pigeon chest, where the breastbone pushes forward. We look at the symptoms and treatment options.READ MORECauses of uneven shouldersMedically reviewed by Angela M. Bell, MD, FACP A person might have uneven shoulders for various reasons. 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