🌊 Pectus excavatum is caused by abnormal growth of costal cartilage and bone in the anterior chest wall, typically involving ribs 4–5 on each side.
It produces a characteristic concave "funnel chest" appearance of the sternum.
📖 About
- Most common chest wall deformity (~1 in 1000 children).
- Presents in childhood and often worsens during adolescence.
- Primarily cosmetic, but can affect cardiopulmonary function in moderate–severe cases.
⚠️ Risks and Associations
- Male predominance (~3:1).
- Most prevalent in white ethnic groups.
- Linked to connective tissue disorders: Marfan syndrome, Ehlers–Danlos syndrome, Poland syndrome.
🧬 Aetiology & Pathophysiology
- Characterised by inward displacement of the sternum → “sunken chest.”
- Severe cases can displace the heart to the left and reduce thoracic volume.
- Results in cardiac compression, impaired venous return, and reduced lung expansion.
🩺 Clinical Presentation
- Exertional dyspnoea and reduced exercise tolerance.
- Chest pain, palpitations; may coexist with mitral valve prolapse.
- Psychological distress: low self-esteem, avoidance of sports/swimming, social withdrawal.
🔍 Investigations
- Chest X-ray: initial screening for deformity.
- CT scan: quantifies severity using the Haller Index (ratio chest width : sternum–spine distance;>3.25 = severe).
- Pulmonary function tests: may show ↓ forced vital capacity (FVC).
- Echocardiography: assesses cardiac compression & mitral valve involvement.
🛠️ Management
- Observation: Mild, asymptomatic cases.
- Surgical correction: indicated if symptomatic, Haller index >3.25, or severe psychosocial impact.
- Nuss procedure (minimally invasive): curved bar placed under sternum to elevate chest wall; best in adolescents with flexible chest walls.
- Ravitch procedure (open): excision of abnormal cartilage + sternal osteotomy; used for severe or asymmetric deformities.
📚 References
💡 Clinical Pearl:
Think of a teenager with a “sunken sternum” + exertional breathlessness.
👉 If cardiac compression, abnormal echo, or reduced lung capacity is present → early referral for surgical evaluation.
