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Chest wall deformities, including pectus excavatum and pectus carinatum

Diagnosing and treating chest wall deformities

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Chest Wall Deformities

Shriners Hospitals for Children specializes in a variety of common chest wall deformities, from severe cases that are apparent in infancy to mild cases that aren't diagnosed until adolescence. Families should connect with a team of experienced pediatric orthopaedic specialists as soon as they notice symptoms or their child’s pediatrician refers them for evaluation. If left untreated, chest wall deformities can lead to persistent respiratory problems, low endurance, and stunted growth and development.

What causes chest wall deformities?

Chest wall deformities are congenital conditions, which means they are present at birth. An abnormal growth of the cartilage that connects the ribs is present in these cases, though experts are unsure of why this happens. Some types of chest wall deformities tend to become more pronounced during the growth spurts of early adolescence, which can be an emotionally trying experience for a developing child.

Types of chest wall deformities

Shriners Hospitals for Children has extensive experience treating chest wall deformities. We work closely with the family to educate you on your child’s condition and to keep you informed of the care plan and expectations. We deliver unrivaled, evidence-based care in a collaborative, compassionate way.

Common chest wall deformities we treat:

  • Raised chest or pigeon chest (pectus carinatum): This condition causes the sternum, or breastbone, to protrude outward. It typically becomes apparent during pre-adolescence, but may be diagnosed earlier in some children. It tends to get more pronounced as the child grows, and is also more likely to occur in boys. Great strides have been made in treating this sort of ballooning of the chest, thanks in large part to innovative minimally invasive and noninvasive medical breakthroughs that Shriners Hospitals for Children has since implemented to better serve our patients.
  • Sunken chest or funnel chest (pectus excavatum): This can best be described as the inverse of a raised chest. Pectus excavatum results in a seemingly collapsed breastbone. It's the most common congenital chest wall deformity and is particularly dangerous as it can compress or displace the heart and/or lungs. Since 1998, our orthopaedic teams have been able to reduce surgeries with a minimally invasive technique called the Nuss procedure. More recently, our Northern California hospital is conducting a groundbreaking study that employs magnets to correct the sunken chest. Both use minimally invasive surgical techniques to reduce surgical time, improve post-surgical discomfort, and decrease recovery time.
  • Poland's syndrome: This more rare type of chest wall deformity primarily impacts one side of the chest. The degree to which this happens varies from patient to patient. Some have rib abnormalities, for example, while others exhibit underdeveloped muscle. It creates asymmetry in the chest and may also lead to other abnormalities on the same side of the body, such as hand or arm irregularities.

Treatment and management approaches

Deciding on the best course of treatment for a chest wall deformity depends on the nature and severity of each case. Shriners Hospitals for Children believes that every child requires their own plan for customized specialty care. The diagnosis never stands alone.

Our interdisciplinary team may include orthopaedic surgeons, physiotherapists, pulmonologists, medical imaging specialists, cardiologists, plastic surgeons and other pediatric specialists.

The course of treatment will depend on the type of deformity and its level of complexity. Sometimes no treatment is recommended while other times, bracing or surgery may be the best option for optimal outcomes. Specialized surgery to reshape the chest may be recommended. The severity and type of chest wall deformity will determine the surgical approach and supporting care required.

Shriners Hospitals for Children is also currently conducting research to explore using minimally invasive magnetic technology to address sunken chest.

Treatments include:

  • Nuss procedure: This is a minimally invasive surgery that places a stainless bar to fit the chest wall. The bar is inserted and secured through a small incision under each arm using the aid of an endoscope to monitor and avoid injury to the surrounding organs during placement. The ends of the bar are secured to the chest wall. This Nuss procedure takes approximately two hours and removal takes approximately one hour.
  • Ravitch procedure: This procedure is performed through a horizontal incision across the mid chest. In this repair, the abnormal costal cartilages are removed, preserving the lining of cartilage, thus allowing the sternum to move forward in a more normal position. This procedure takes approximately four to six hours.
  • Chest braces: Pediatric Orthotic and Prosthetic Services (POPS), LLC, at Shriners Hospitals for Children designs and creates customized braces that apply direct pressure to the chest for children with pectus carinatum. This safely reshapes the chest without surgery.

Conditions, treatments and services provided may vary by location. Please consult with the Shriners Hospitals for Children location nearest you. See zip code search feature to the right.

Request an Appointment

Most major insurance providers are accepted; however, insurance coverage is not required for care. Any child under 18 with a medical condition or medical need that is within the health care system’s scope of services, is eligible for care. Shriners Hospitals for Children offers financial assistance to those in need.
800-237-5055

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22 Locations Across North America

Location Specialties
  • Burn Care
  • Craniofacial and Cleft Lip/Palate
  • Neuromuscular
  • Orthopaedics
  • Orthotics and Prosthetics
  • Pediatric Surgery
  • Spinal Cord Injury
  • Sports Injury and Fractures
  • Therapy and Rehabilitation

Notice: Treatments and services vary by location. Contact nearest hospital for specific details.

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