Pectus carinatum (pigeon chest) occurs when the cartilage, the bones of the sternum (breastbone) and ribs do not properly form. As a result, the chest becomes abnormally pushed outward. The condition often goes unnoticed until puberty, when rapid growth and development may intensify the appearance of the defect.
Symptoms are less frequent with this type of deformity than with pectus excavatum and many patients will not require surgical correction. When symptoms are present, patients may experience pain in the chest, ribs and back as well as shortness of breath. There may also be a psychological or social impact if the patient is concerned about the appearance of his/her chest wall.
How is pectus carinatum diagnosed?
Our patients go through a series of diagnostic testing, including:
- A chest X-ray (or CT chest scan) to evaluate the extent of the pectus defect and the internal chest anatomy and structure
- Metal allergy testing for bar placement that's used in certain treatments, performed in collaboration with our pedatric dermatology team (Patients with a allergy to nickel will require a special type of bar be placed.)
How is pectus carinatum treated?
Treatment options include chest-wall bracing and/or surgery. Many patients with mild or moderate cases of pectus carinatum experience success with advanced chest-wall braces. Adolescents with more severe or refractory cases of pectus carinatum may require a modified Ravitch surgical repair.
If your child has mild pectus carinatum, a surgeon may recommend a chest-wall brace. This works similar to orthodontic braces on a child's teeth. By applying steady pressure over time, the sternum can be gradually reshaped. Patients must wear the brace for 14 to 23 hours a day for several months. It is extremely important that patients wear the brace as much as possible on a daily basis. Once the desired degree of correction has been achieved, patients will only need to wear the brace at night in order to maintain the corrected shape.
The vast majority of patients who are diligent about wearing their brace as directed see successful treatment with this noninvasive approach. If your surgeon recommends a custom-fitted chest-wall brace, he or she will discuss the protocol in more detail with you and your child.
During the Ravitch procedure, an incision is made along the chest wall over the sternum. Surgeons at Comer Children's use a modified Ravitch approach, which involves making incisions as small as possible. A surgeon will remove cartilage around the area of deformity, detach the sternum and then reposition it. Sometimes, a small metal bar is also placed under the sternum to support it in the desired position. The bar is usually left in place for about two years until the cartilage can solidify in the new corrected position. The operation to remove the bar is performed on an outpatient basis.