Pectus excavatum (1934)

What is Pectus Excavatum? 

Pectus Excavatum is when the rib cage does not develop as it should.  The breastbone (sternum), which is in the center of the chest, is sunken or caved in.  This sunken area, or depression, in the sternum is the pectus.  It causes the rib cage to look unequal. Your child may have been born with pectus. The condition often gets worse as your child grows.  It is sometimes called a sunken chest or just pectus.  

How is it treated?

A grading system is used to talk about the depth of the sunken chest.  It includes mild, moderate and severe pectus.  Treatment is based on the depth of the pectus.

• Mild pectus. Exercise often helps by making the chest muscles stronger.  This can help with better posture which may improve the appearance of your child’s chest.
• Moderate to severe pectus. Surgery may be recommended as the lungs and heart may be affected by the lack of space in the chest. Your child may have trouble breathing, get short of breath easily and complain of chest pain during exercise. During surgery the sternum is lifted upward. This is done with one of two procedures.  
  – Nuss procedure. A steel bar is used to push out the sternum. The steel bar stays in your child’s chest for 2 to 3 years. It is taken out during another surgery. The steel bar keeps the breastbone in a more normal position while your child grows.
  – Ravitch procedure. Abnormal cartilages are removed which allows the sternum to return to a more normal position. Sometimes a steel bar is left in place for about 6 months. Another surgery is needed to remove the bar.

What tests will be needed?

• An MRI may be done. This is a special machine that uses magnets to create a picture to help the doctor decide how to treat the pectus. It will also show if your child’s heart and lungs are being affected by the pectus.
• Pulmonary function tests, a stress test, and/or an Echocardiogram may also be needed.