PECTUS CARINATUM

TYPES

The two main types of pectus carinatum are:

1. Chondrogladiolar Pectus Carinatum: In this type, the protrusion is mainly localized to the lower part of the sternum, known as the xiphoid process or the gladiolus. The upper part of the sternum remains relatively normal in shape.

2. Chondromanubrial Pectus Carinatum: This type involves a protrusion of the upper part of the sternum, known as the manubrium. The lower part of the sternum may appear relatively normal or have a less prominent protrusion.

It’s worth noting that these types of pectus carinatum may vary in severity, with some individuals experiencing a more pronounced outward protrusion than others.

In addition to these main types, there may be variations or combinations of pectus carinatum, depending on the specific location and extent of the protrusion. Each case may require individualized evaluation and treatment based on the unique characteristics of the deformity.

SYMPTOMS

Pigeon chest, also known as pectus carinatum, is a malformation of the chest wall characterised by an outward protrusion of the sternum and ribs. Pectus carinatum is largely an aesthetic issue, however it sometimes manifests as physical issues. The following are some typical signs and symptoms of pectus carinatum:

1. Deformity: The outward protrusion of the sternum and ribs, which gives the chest a distinct look, is the most obvious sign. From mild to moderate to severe, the deformity’s severity might vary.

2. Breathing problems: Pectus carinatum sometimes results in limited lung capacity, which causes shortness of breath, particularly after strenuous physical activity. This might lead to a decreased capacity for activity or trouble engaging in certain sports.

3. Chest discomfort or pain: Pectus carinatum, especially in severe instances, may cause chest discomfort or pain. Pressure on the chest wall or related musculoskeletal alterations might be to blame for this.

4. Reduced stamina and physical performance: Individuals with pectus carinatum may experience decreased endurance and reduced physical performance due to the altered chest wall shape and potential respiratory limitations.

5. Body image concerns: The visible deformity of the chest can lead to self-consciousness and body image concerns, particularly during adolescence when appearance and self-esteem may be more prominent.

DIAGNOSIS

The diagnosis of pectus carinatum, also known as pigeon chest, is typically made through a combination of physical examination and imaging tests. Here is an overview of the diagnostic process for pectus carinatum:

1. Physical examination: A healthcare professional, such as a pediatric surgeon or thoracic surgeon, will perform a thorough physical examination to assess the chest wall deformity. They will visually observe the outward protrusion of the sternum and ribs and palpate the chest to confirm the presence of pectus carinatum.

2. Medical history: The healthcare professional will also take a detailed medical history, including any symptoms experienced, the age of onset, and the progression of the deformity. They may ask about any associated conditions, family history, or previous treatments.

3. Imaging tests: To further evaluate the severity of the deformity and assess any potential underlying structural abnormalities, imaging tests may be ordered. These can include:

• Chest X-ray: This can provide a two-dimensional image of the chest, allowing the healthcare professional to visualize the position of the sternum and ribs.
• Computed tomography (CT) scan: A CT scan can provide detailed cross-sectional images of the chest, offering a more comprehensive assessment of the chest wall deformity and any associated abnormalities.
• Three-dimensional imaging: In some cases, three-dimensional imaging techniques, such as computed tomography angiography (CTA) or magnetic resonance imaging (MRI), may be used to obtain a more detailed evaluation of the chest wall deformity.

TREATMENT

The treatment for pectus carinatum, also known as pigeon chest, depends on the severity of the deformity and the presence of any associated symptoms. Here are the main treatment options for pectus carinatum:

1. Observation: In mild cases where the deformity is not causing significant symptoms or functional limitations, observation alone may be recommended. Regular check-ups with a healthcare professional can help monitor the progression of the deformity and assess any changes.

2. Bracing: For moderate to severe cases of pectus carinatum, bracing may be recommended. This involves wearing a custom-made chest brace, typically made of plastic or foam, which applies pressure on the protruding area of the chest. The brace is worn for several hours each day, usually for several months or longer. The goal of bracing is to gradually reshape the chest wall and reduce the outward protrusion.

3. Physical therapy: In addition to bracing, physical therapy exercises may be prescribed to improve posture, strengthen the chest muscles, and promote better alignment of the chest wall. These exercises can help enhance chest flexibility and potentially reduce the deformity’s prominence.

4. Surgical intervention: In more severe cases of pectus carinatum or when conservative treatments are not successful, surgical correction may be considered. The most common surgical procedure for pectus carinatum is called the Ravitch procedure or open chest wall repair. This involves making incisions in the chest wall and repositioning the sternum and ribs to a more normal position. Another less invasive surgical option is the use of a minimally invasive technique called the Nuss procedure, where a curved metal bar is inserted beneath the sternum to reshape the chest.