OVERVIEW

What is pectus carinatum?

Pectus carinatum is a rare chest wall deformity, primarily caused by abnormal development of the sternum and ribs. When ribs grow faster than the sternum, upward pressure on the sternum forms pectus carinatum, while downward pressure results in pectus excavatum.

Pectus carinatum can be congenital or acquired. Most congenital cases have unknown causes, while acquired cases often stem from childhood nutritional deficiencies (e.g., lack of vitamin D or calcium).

Most children with pectus carinatum experience no significant discomfort, and the deformity alone does not lead to other diseases or life-threatening conditions. However, it does not resolve spontaneously. Surgical correction may be considered for cosmetic concerns.

What are the characteristics of the affected population?

Pectus carinatum is more common in males than females, with a male-to-female ratio of approximately 4:1. Since the deformity becomes noticeable during puberty, most patients are diagnosed after age 11.

SYMPTOMS

What are the manifestations of pectus carinatum?

Pectus carinatum primarily causes changes in physical appearance: the sternum protrudes forward, resembling the breast of a chicken or pigeon. It generally does not cause discomfort or affect cardiopulmonary development.

However, some patients with pectus carinatum may experience symptoms related to impaired cardiopulmonary function, such as shortness of breath after activity, chest tightness, reduced physical activity, and increased susceptibility to lung infections or asthma. These symptoms are more common in underweight children.

What psychological issues do patients with pectus carinatum face?

Pectus carinatum becomes more noticeable during adolescence, a period when patients are highly self-conscious. The chest deformity can lead to low self-esteem and a range of psychological issues, such as anxiety, social withdrawal, body image concerns, and aggression.

As patients age, these problems may worsen, potentially leading to psychological disorders such as alcohol and drug abuse, suicidal tendencies, and obsessive-compulsive disorder.

What other conditions are associated with pectus carinatum?

15%–30% of pectus carinatum patients may also have spinal abnormalities or scoliosis.

Additionally, pectus carinatum may be linked to Marfan syndrome, Noonan syndrome, cardiofaciocutaneous syndrome, Poland syndrome, osteogenesis imperfecta, Coffin-Lowry syndrome, and Morquio disease.

If pectus carinatum is accompanied by other physical deformities or abnormalities, it may indicate one of the aforementioned syndromes rather than isolated pectus carinatum.

CAUSES

What are the causes of pectus carinatum?

The exact cause is not yet fully understood.

Congenital pectus carinatum is primarily caused by imbalanced and uncoordinated development of the sternum and ribs. Overgrowth of the ribs pushes the sternum forward. Some children have a family history of the condition and may also have other congenital disorders, such as congenital heart disease, congenital diaphragmatic hernia, or congenital torticollis.

Acquired pectus carinatum is mostly a manifestation of rickets, which often results from vitamin D deficiency in children, leading to poor calcium and phosphorus absorption and subsequent bone development disorders.

DIAGNOSIS

Which department should a patient with pectus carinatum visit in the hospital?

The incidence of pectus carinatum is not particularly high, and many hospitals do not perform corrective surgery for this condition. If the local hospital does not offer this procedure, patients can visit the pediatrics department and then, based on treatment needs, seek a hospital that performs pectus carinatum correction surgery. Departments that may offer this surgery include pediatric surgery, plastic (corrective) surgery, and thoracic surgery.

What tests do patients with pectus carinatum need?

• Chest X-ray or chest CT: These can visually assess abnormalities in the shape of the sternum and ribs, diagnose pectus carinatum, and help determine its severity.

• Electrocardiogram (ECG) and echocardiogram: These primarily evaluate whether pectus carinatum affects the heart and assist in assessing its severity.

• Pulmonary function test: This mainly evaluates whether pectus carinatum affects the lungs and helps determine its severity.

TREATMENT

Does pectus carinatum always require treatment?

Most cases of pectus carinatum do not cause discomfort or adverse consequences and may not require treatment. Treatment may be considered under the following circumstances:

• It affects appearance, causing psychological distress for the child and parents.

• The chest wall deformity compresses the heart and lungs, leading to reduced activity, shortness of breath, chest tightness, or abnormal cardiopulmonary function test results.

What are the treatment options for pectus carinatum?

There are two approaches: conservative treatment and surgical treatment.

What is conservative treatment for pectus carinatum?

• Conservative treatment is suitable for younger patients (5–10 years old) or those with mild conditions. It mainly includes improving nutrition, supplementing calcium and vitamin D, increasing physical exercise, and using orthopedic braces to correct the deformity.

• Brace treatment may last 1–2 years, but compared to surgery, it avoids complications and high costs.

Which physical exercises are helpful in conservative treatment for pectus carinatum?

Push-ups, chest expansion exercises, dumbbell front raises, jogging, and other sports can help. Exercise increases chest dimensions and muscle thickness, partially masking the deformity.

When does a pectus carinatum patient need surgery?

Surgery is recommended for moderate to severe chest wall deformities, poor chest wall elasticity, combined funnel chest, inability to adhere to brace treatment, or failed brace therapy.

What surgical treatments are available for pectus carinatum?

Surgery for pectus carinatum has a history of decades. Initially, the "sternal depression technique" was used, which involved large incisions, prolonged recovery, visible scars, and many complications.

With advancements in surgical techniques, the "reverse NUSS procedure" is now widely used.

The "reverse NUSS procedure" is minimally invasive, with hidden incisions, faster recovery, and less impact on lung function compared to the sternal depression technique.

This procedure requires steel plate fixation, which is typically removed after 2–3 years, depending on the patient's age.

Can all pectus carinatum patients be cured with the reverse NUSS procedure?

Not all patients achieve satisfactory results. Surgical outcomes depend on the severity of the deformity, associated abnormalities, the suitability of the steel plate, and the surgeon's skill.

How should pectus carinatum patients follow up after surgery?

Post-surgery, patients should undergo chest X-rays and CT rib reconstructions at 3, 6, 12, and 18 months to monitor chest remodeling and check for complications.

What is the best age for surgical treatment of pectus carinatum?

The optimal age for surgery remains debated. In China, surgery is typically performed after age 10. Internationally, the generally accepted best age is around 13–16 years.

However, age is not the sole factor. Surgery may be performed earlier if the deformity causes cardiopulmonary dysfunction or worsens rapidly. Older patients who require correction should also receive treatment.

DIET & LIFESTYLE

How long after pectus carinatum surgery can one start exercising?

Exercise can begin 3 months after surgery. Initially, activities like chest expansion and jogging are recommended, while movements that cause chest bending (such as forward or backward rolls) should be avoided.

After 6 months, unrestricted activities like push-ups and gymnastics are permissible.

Additionally, to promote faster recovery of lung function, children can start balloon-blowing exercises 1 month post-surgery—2–3 times daily for about 10 minutes each session—to help the previously compressed lungs expand and return to normal.

How soon can pectus carinatum patients return to school after reverse NUSS surgery?

Younger children may attend kindergarten 3 months post-surgery, while school-aged children can return immediately after discharge. However, the chest must be protected from external impact to avoid hindering healing and compromising surgical results.

What should pectus carinatum patients pay attention to after reverse NUSS surgery?

For the first 3 months post-surgery, sleep primarily on the back on a flat mattress. Maintain an upright posture with chest out and back straight. Uncooperative children should wear a shaping protective vest for about 3 months. Avoid vigorous scrubbing of the wound for 2 weeks after healing.

PREVENTION

How to prevent pectus carinatum?

The cause of congenital pectus carinatum is still unclear, and there are currently no effective prevention methods.

Acquired pectus carinatum is mostly caused by nutritional deficiencies (such as lack of vitamin D and calcium), so it can be prevented. The prevention method is to supplement children with vitamin D on time and in the recommended dosage. Recommendation: Starting from 2 weeks after birth, provide 400 IU of vitamin D daily until adolescence or even adulthood, with vitamin D3 capsules being the preferred choice.