Pectus Excavatum, also known as 'sunken chest', 'pigeon chest' or 'funnel chest' is the most common chest-wall disorder in humans. The condition involves a deformity in the growth of the sternum or 'breast-bone', which grows inward causing an indent in the chest. While for some people, this indent is mild, and only cosmetic, other individuals, usually with more severe indents, experience physical symptoms.
In this guide, we will go over exactly what is Pectus excavatum, what causes it, how it's diagnosed, and the best available treatment options.
Understanding Pectus Excavatum
The underlying pathophysiology of Pectus excavatum is caused by abnormal growth of the sternum and surrounding cartilage in the chest. This growth causes the sternum to grow inward rather than flat and creates a dip or 'funnel' of varying severity. The issue is quite common, and occurs in approximately 1 in 400 men, and 1 in 1000 women respectively. The dip in the chest is usually noticeable during childhood and most always grows in severity as the child enters the adolescent growth phase.
What causes Pectus Excavatum?
The exact cause of Pectus excavatum is not fully understood, but the abnormal growth of the cartilage is most likely caused by a genetic factor that often runs in families. It's not uncommon for multiple people in one family to have the condition. Pectus excavatum is inherited at birth and is not caused by any lifestyle factors such as bad posture or malnutrition.
How is Pectus Excavatum diagnosed?
The condition can usually be seen and diagnosed quite clearly with the naked eye in men. However, with women, the growth and shape of the breasts can often hide the extent of the deformity. A CT scan or MRI of the chest is the best way to diagnose the condition in women, and check for severity and impact to the organs in men also.
A CT scan is most often used to measure the severity of the condition, also known as 'haller index'. The Haller index is a number obtained by a calculated the ratio of the chest's width diameter to its depth diameter, obtained from a CT scan. A normal Haller index is 2.5 or less and measurements above 3.25 are considered severe Pectus excavatum. The Scan is also useful to determine the effect of the Pectus indent on the heart and lungs. More severe cases can physically push down and displace the heart and lungs, causing physical symptoms such as exercise intolerance and heart palpitations.
Pectus Excavatum Symptoms
Symptom severity with Pectus excavatum is dependant on the severity of the chest indent. Those with cosmetic and milder cases may experience no symptoms, but others with more moderate to severe cases usually experience some negative symptoms. More moderate Pectus excavatum causes the sternum to physically press down on the heart and lungs, which can affect their function. The most common physical symptoms associated with moderate Pectus excavatum are:
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Shortness of breath during exercise
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Heart palpitations
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Reduced stamina or exercise intolerance
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Feeling of the heart beating against the chest
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Postural problems such as forward posture
Pectus excavatum also usually carries secondary issues, such as forward posture and rounding of the shoulders. Patients can often have flared lower ribs which protrude outward, and scoliosis of the spine.
Treatment options for Pectus Excavatum
There are multiple effective treatment options available for Pectus Excavatum, however, the appropriate treatment choice depends on key factors such as the patients age, depth severity and presence of physical symptoms.
Non surgical options include the Vacuum Bell Treatment for Pectus Excavatum. This device consists of a silicone suction cup with an attached hand pump that creates a vacuum over the chest. Over repeated use, the sunken sternum can be pulled up to a normal position by vacuum pressure. The treatment method is completely painless and non-invasive, however requires strict adherence to a daily wearing schedule for at least 12 months. This treatment method is most effective for patients aged under 18, and older patients with milder defects.
The Nuss procedure is the most popular surgery for Pectus Excavatum in patients with more moderate and symptomatic defects. This procedure uses a steel bar to push the up into a normal position. The bar is left inside the patient for about 4 years until the chest has stabilized into a normal position. Treatment outcomes are often very good with the Nuss procedure, although the surgery is often quite painful and can involve complications such as bar displacement.
The Ravitch Procedure is a surgical method that was popular before the advent of the Nuss Procedure, but is quickly growing out of favour with health professionals, as results tend to be poorer and complications higher. This surgery involves physical cutting and reshaping of the abnormal chest cartilage, it is only still used in unusual cases of Pectus excavatum where the Nuss is deemed inappropriate.
Psychological symptoms of Pectus Excavatum
For many patients living with the condition, the impact of the condition is more about body confidence rather than direct physical symptoms. The abnormal appearance of the chest can cause issues with self-esteem and body-image. This is especially true in teenagers and young adults who are more sensitive to how they look. Children and teens may have severe physical distress about how they look, such as being afraid or unwillingly to take their shirt off in public, such as at the pool. Exercises and movements which correct posture and build muscle in the upper body can improve the look of the condition and help with body image issues.
Key Takeaways
Pectus excavatum is the most common chest-wall disorder in humans. The condition causes the breastbone to grow inward, creating a sunken appearance. While milder cases are often only cosmetic, more severe indents do carry physical symptoms which can be treated by surgical and non-invasive methods. Parents who suspect their child has Pectus excavatum should consult with a medical doctor for an evaluation. Early diagnosis of the condition is useful, and children can often be treated effectively with non-invasive methods such Vacuum Bell Therapy.
References
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Mayo Clinic Staff. Pectus excavatum: Symptoms & causes. Mayo Clinic. March 14 2025. Retrieved from Mayo Clinic. Mayo Clinic
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van Braak, H., de Beer, S. A., Al Ghouch, Y., Zwaveling, S., Oomen, M. W. N., van Heurn, L. W. E., de Jong, J. R. (2025). 15 Years of vacuum bell therapy for pectus excavatum: Long-term outcomes and influencing factors. Journal of Pediatric Surgery, 60 (2), 161891. Epub ahead of print September 1 2024. doi:10.1016/j.jpedsurg.2024.161891. Retrieved from PubMed. PubMed
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Johns Hopkins Medicine. Pectus excavatum. Johns Hopkins Medicine. [Last update not specified]. Retrieved from Johns Hopkins Medicine. Hopkins Medicine