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, which can cause it to either sink inward or protrude outward.
These chest wall deformities can range from mild and mostly cosmetic, to severe and symptomatic to physical 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 very close to the spine, almost 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 in girls. Symptoms range in severity depending on the depth of the dent, with shortness of breath with exertion and reduced stamina being very common, even in seemingly moderate 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 delivers excellent results in most patients. The Procedure involves a surgeon making two small cuts on either side of the chest, with two curved steel bars usually inserted into the chest cavity. The bars are then flipped to push the chest outward. The bars are kept in for 2-3 years before being removed in 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 suction that lifts the chest in about 30 minutes.
The Vacuum Bell is often used in less severe cases where surgery is neither necessary nor appropriate. It can also be utilized in more moderate cases when surgery is unobtainable or undesired by the patient. The duration of therapy is usually 30 minutes to 2 hours daily for at least a year.
Pectus Carinatum
Pectus 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 in girls and often becomes noticeable 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 those of Pectus Excavatum in that it is usually only cosmetic. In Carinatum, the sternum protrudes outward rather than inward and does not put pressure on the heart and lungs, unlike in Excavatum.
Whilst they are usually only cosmetic, the symptoms can still negatively affect 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 as dental braces do, the cartilage of the chest wall can be reshaped over time with consistent pressure.
Bracing for Pectus Carinatum involves a specially tailored brace worn around the chest that applies inward pressure on the sternum.
The therapy usually lasts about 1 year, with the brace worn 12 to 23 hours per day. It is most effective during the adolescent stage of development, when the chest wall is still soft and malleable.
Surgical treatment
Bracing is usually very effective for Pectus Carinatum, but in rare cases where it is ineffective, a surgical procedure called the Modified Ravitch Procedure may 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 after 6 months to 1 year.
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 usually only cosmetic in nature and not detrimental to physical health.
Both conditions have effective treatment options: the Nuss Procedure and Vacuum Bell for Pectus Excavatum, and adolescent bracing for Pectus Carinatum.
