Children's Hospital Colorado

Pectus Excavatum

What is pectus excavatum?

Pectus excavatum, also known as "funnel chest" or "sunken chest," is a chest wall disorder. Children with this condition have a chest that caves into the body instead of curving out. This is a condition that kids can be born with, but it often does not develop until children go through their adolescent growth spurt. Pectus excavatum varies greatly in severity.

What causes pectus excavatum?

There is no known cause of pectus excavatum, however it develops when the rib bones and cartilage that make up the anterior chest wall develop abnormally. Due to extra cartilage growth during development, the sternum gets progressively pushed inward resulting in a caved- in chest.

Who gets pectus excavatum?

Chest wall deformities cannot be prevented and are a relatively common abnormality during development. Pectus excavatum is much more common in boys than girls. Families affected by chest wall deformities often have more than one person with pectus excavatum.

What are the symptoms of pectus excavatum?

Many people with pectus excavatum only experience the physical appearance differences of a sunken chest. However, due to the sunken or concave chest, this condition can impact the underlying function of the heart and lungs. Some people experience:

  • Chest pain
  • Low energy
  • Shortness of breath
  • Fast heart rate (tachycardia)

The above symptoms are often made worse with or exacerbated by activity.

As children with pectus excavatum grow, the indent in the chest often continues to worsen without treatment.

The impact of a concave chest on self-confidence and social activities

The differences in physical appearance from pectus excavatum (a concave chest) can cause low self-esteem and decreased social interactions.

If a child, teen or adult does not get treated for this condition, he or she may also continue to limit participation in physical activities like sports and exercise due to heart and lung complications.

What tests are used to diagnose pectus excavatum?

When you visit Children's Hospital Colorado for pectus excavatum, you will meet with a care team that includes a pediatric surgeon who specializes in this condition. The care team will record your child's medical history and complete a physical evaluation of his or her sunken chest wall. In addition, the care team may also choose to run one or more of the below tests: 

  • Chest X-ray – a picture of the chest, heart and lungs
  • Computed tomography (CT scan) – shows what is happening on the inside of the sunken chest and can demonstrate underlying changes to the heart and lungs
  • Electrocardiogram (EKG) – a non-invasive test that records the heart beat
  • Echocardiogram (ECHO) – shows the structure and blood flow within the heart
  • Lung function tests

How is pectus excavatum treated?

Mild cases of pectus excavatum usually do not need surgery, however if recommended by your doctor, pectus excavatum can be treated with surgery. Children who are bothered by the physical appearance of a sunken chest or who have more serious depression that interferes with breathing or heart function usually need to have an operation to elevate the sternum and create a more normal or "neutral" appearance of the chest wall. The goal of surgery is to repair the chest deformity and increase the performance of the heart and lungs.

The optimal age for pectus excavatum surgery is between 12 and 17 years of age because younger patients tend to recover quicker from the procedure and obtain benefits sooner during their growth. In some severe cases, the repair may be done sooner. It can be done in older patients as well.

Pectus excavatum surgery at Children's Hospital Colorado

The Nuss procedure is a minimally-invasive surgery that realigns the depressed sternum (funnel chest) with the rest of the chest wall. A specially designed metal bar is inserted into the chest beneath the ribs and sternum to raise them into a more normal position. The procedure provides improved heart and lung function as well as the psychological benefits of increased self-esteem.

The bar is typically left in place for approximately two to three years to allow the bones and cartilage to become fixed in place and mature to decrease the risk of recurrence. At that time your child will be scheduled for surgery to have the bar removed. This is usually done as a day surgery, so no overnight stay is required.

Why choose Children's Colorado for your child's pectus excavatum treatment?

Our pediatric care team is one of the most experienced teams in the Rocky Mountain region specializing in chest wall deformity treatment. Patients and families are supported by a team of experts dedicated to caring for kids and teens before, during and after surgery including:

  • Pediatric surgeon
  • Pediatric anesthesiologist
  • Physical therapist
  • Pediatric nurses
  • Pediatric radiologists

When surgery is recommended, our families can rest assured knowing we offer:

  • Anesthesiologists who are specialized in keeping kids safe and pain-free during surgery
  • Kid-sized equipment, from radiology imaging to the operating room
  • Age-appropriate information about what to expect from surgery for patients and siblings
  • Collaboration and communication with your primary care doctor to ensure a smooth transition after surgery

Learn more about Pediatric Surgery at Children's Colorado.

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