Facts about a common chest disorder in children – Pectus Excavatum (Sunken Chest)

Pectus excavatum or sunken chest is one of the most common chest wall disorders in children. The opposite condition can also occur - the chest wall sticks out called pectus carinatum, or pigeon chest. However, pectus excavatum is more common. While these conditions can be seen in infancy and childhood, chest disorders usually become more obvious as children grow.

These chest wall conditions are not life-threatening. However, some sunken chest walls might cause discomfort such as: difficulty breathing, chest pain, fatigue and difficulty playing sports because of the pressure on the chest. It may be associated with scoliosis. Depending on how sunken the chest wall is and if there are any symptoms, surgery may or may not be needed. 

• Pectus excavatum occurs in approximately one out of 400 children 
• It’s more common in boys than girls 
• Pectus excavatum tends to occur in families, suggesting genetics could play a role 
• The chest may look more sunken in as a child grows 
• It’s commonly caused by an abnormality in cartilage that connects to the ribs to the breastbone 
• It can cause social anxiety, depression, loss of motivation, not wanting to participate in sports, and avoiding beaches and pool parties

Diagnosis

The sunken chest is normally noticed by a parent/caregiver or by a physician during a routine exam. If the patient, family and surgeon decide that surgery is needed, the following tests may be ordered:

• Computed tomography (CT) of chest – detailed pictures are taken of the chest (similar to x-rays)
• Echocardiography – ultrasound of the heart 
• Lung function tests
• Exercise stress testing

Treatment

“We see a lot of cases of pectus excavatum in both our ACH and ACNW clinics,” said Dr. Sid Dassinger, Chief of Pediatric Surgery. “Our team of pediatric surgeons have specialized training in diagnosing and treating all types of chest wall conditions in children and use the latest approaches to surgical intervention.”

For nearly two decades, the pediatric surgeons at Arkansas Children's have corrected pectus excavatum using a minimally invasive technique called the Nuss procedure. The team also uses cryoablation, which temporarily freezes the nerves in the area of the surgery to help block pain. This helps control pain and shortens the hospital stay.