Pectus Excavatum vs Carinatum

Pectus Excavatum and Pectus Carinatum are both the most common chest deformities, affecting roughly 1 in 400 and 1 in 1000 people respectively. They involve abnormal growth of the intercostal cartilage surrounding the sternum, causing it to either sink inward or protrude outwards.

These chest wall deformities can range from mild and mostly cosmetic, to severe and symptomatic to psychical health. Both conditions often run in families and appear in childhood, but what are the differences between the two conditions?

Pectus Excavatum

Pectus Excavatum, also known as funnel chest, or sunken chest, is a chest wall deformity that causes the sternum to grow inward. This causes a 'hole' or 'funnel' in the chest ranging from mild to severe. In severe cases the sternum can sink down very close to the spine, coming close to touching it. In these cases, the heart is usually displaced, and pressure is put on the lungs.

The condition can be apparent at birth, but often becomes more noticeable during the adolescent growth phase. It is more common in boys than girls. Symptoms range in severity depending on the depth of the dent, with shortness of breath upon exertion and lack of stamina being very common, even in seemingly moderated cases.

Other associated symptoms include: slouched posture, curvature of the spine, 'pot-belly' and outward flaring of the ribs. Treatment for Pectus Excavatum is effective at lifting the sternum away from the organs and relieving symptoms.

There are multiple effective treatment options available for Pectus Excavatum, two of the most common are:

Surgical treatment

The Nuss Procedure surgery is often used for moderate to severe cases and usually deliverers excellent results in most patients. The Procedure involves a surgeon making two small cuts on either side of the chest, with usually two curved steel bars being inserted inside the chest cavity. The bars and then flipped to push the chest outward. The bars are kept in for 2-3 years before being removed by a second surgery.

Vacuum Bell Therapy

Vacuum Bell Therapy is a non-invasive alternative to the Nuss Procedure for Pectus Excavatum. The device consists of a silicone 'bowl' that has a hand pump attached. The device is placed over the chest and pumped to create a suction which pulls the chest up over the course of around 30 minutes.

The Vacuum Bell is often used in less severe cases where surgery is not deemed either necessary or appropriate. It can also be utilized in more moderate cases when surgery is unobtainable or undesired by the patient. The duration of the therapy is usually around 30 minutes to two hours daily over at least a year.

Pectus Carinatum

Pecus Carinatum, also known as pigeon chest, is a condition where the sternum sticks outward more than usual. Like Excavatum, it is more common in boys than girls and often appears noticeably in adolescence, worsening into adulthood.

It is also caused by an abnormality in the growth of the intercostal cartilage surrounding the sternum. It also tends to run in families. The symptoms of Pectus Carinatum differ from Pectus Excavatum, in that it is usually only cosmetic. For Carinatum, the sternum protrudes outwards rather than inwards and does not put pressure on the heart and lungs like in Excavatum.

Whilst they are usually only cosmetic, the symptoms can still negatively effect body image and self esteem, and treatment is often recommended for children with Pectus Carinatum, the most effective being bracing.

Bracing treatments

A chest brace is often the first line of treatment for children with Pectus Carinatum. Much like the way dental braces work, the cartilage of the chest wall can be reshaped over time with consistent pressure.

Bracing for Pectus Carinatum involves a specially tailored brace that is worn around the chest and places inward pressure on the sternum.

The therapy usually lasts for a total of about one year, with the brace being worn between 12 and 23 hours per day. It is most effective in the adolescent stage of development where the chest wall is still soft and malleable.

Surgical treatment

Bracing is usually a very effective treatment for Pectus Carinatum, but in rare cases where it is ineffective, a surgery called the Modified Ravitch Procedure might be used.

This procedure involves a surgeon physically removing and reshaping the intercostal cartilage around the sternum, before placing a small steel bar behind the chest to hold it in place. The bar is then removed six months to a year later.

Conclusion

Pectus Excavatum and Carinatum are both congenital chest wall deformities that impact roughly 1 in 400 and 1 in 1000 respectively. Pectus Excavatum causes the sternum to sink inward, and often causes physical symptoms such as exercise intolerance and shortness of breath.

Pectus Carinatum involves the sternum protruding outward and is is usually only cosmetic in nature and not detrimental to physical health.

Both conditions have effective treatment options available, with the Nuss Procedure and Vacuum Bell being used for Pectus Excavatum, and adolescent bracing for Pectus Carinatum.