Pectus Excavatum  (Sunken Chest)

Pectus Excavatum (PE) is a deformity of the chest wall that causes several ribs and breastbone to grown inward to form a depression of the chest, giving it a concave (sunken) appearance. PE 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.

Possible Symptoms

• problems tolerating exercise
• limitations with some kinds of physical activities
• tiredness
• chest pain
• a rapid heartbeat or heart palpitations
• frequent respiratory infections
• coughing or wheezing

Possible 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 

Possible Treatments

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

For the past 15 years, 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.

If you are concerned that your child may have a chest wall disorder or you are seeking treatment, please call us to schedule an appointment with the pediatric general surgeons at Arkansas Children’s.