Pectus excavatum

Pectus excavatum is often a congenital (present at birth) abnormality. Or, it can develop after birth. The condition can be mild or severe.

Pectus excavatum is due to too much growth of the connective tissue that joins the ribs to the breastbone (sternum). This causes the sternum to grow inward. As a result, there is a depression in the chest over the sternum, which may appear quite deep.

If the condition is severe, the heart and lungs can be affected. Also, the way the chest looks may cause emotional stress for the child.

The exact cause is unknown. Pectus excavatum occurs by itself. Or there may be a family history of the condition. Other medical problems linked with this condition include:

• Marfan syndrome
• Noonan syndrome
• Poland syndrome
• Rickets
• Scoliosis

Contact your health care provider if you or your child has any of the following:

• Chest pain
• Trouble breathing
• Feel depressed or angry about the condition
• Feel tired, even when not being active

Your provider will perform a physical examination. An infant with pectus excavatum may have other symptoms and signs that, when taken together, define a specific condition known as a syndrome.

The provider will also ask about medical history, such as:

• When was the problem first noticed?
• Is it getting better, worse, or staying the same?
• Do other family members have an unusual-shaped chest?
• What other symptoms are there?

Tests may be done to rule out suspected disorders. These tests may include:

• Chromosome studies
• Enzyme assays
• Metabolic studies
• X-rays
• CT scan

Tests may also be done to find out how severely the lungs and heart are affected.

This condition can be surgically repaired. Surgery is generally advised if there are other health problems, such as trouble breathing. Surgery may also be done to improve the appearance of the chest. Talk to your provider about treatment options.

Funnel chest; Cobbler's chest; Sunken chest

Boas SR. Skeletal diseases influencing pulmonary function. In: Kliegman RM, Stanton BF, St. Geme, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 417.

Cobben JM, Oostra RJ, van Dijk FS. Pectus excavatum and carinatum. Eur J Med Genet. 2014;57:414-417. PMID: 24821303 www.ncbi.nlm.nih.gov/pubmed/24821303.

Lumpkins KM, Colombani P, Abdullah F. Repair of pectus excavatum. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 11th ed. Philadelphia, PA: Elsevier Saunders; 2014:772-775.

Updated by: Dale Mueller, MD, Cardiovascular and Thoracic Surgeon, HeartCare Midwest; Chairman Department of Cardiovascular Medicine and Surgery, OSF St. Francis Medical Center; and Clinical Associate Professor of Surgery, University of Illinois. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.