Pectus carinatum — commonly known as “pigeon chest”— occurs when abnormal cartilage growth causes the sternum to protrude from the chest.
Pectus carinatum is more prevalent in boys, and it often becomes evident during a child’s preteen or early teenage years. Up to 50 percent of patients will have a close relative with a similar chest wall abnormality.
Most children with this condition do not experience symptoms, but some might feel chest pain during times of accelerated growth and development. Others might experience shortness of breath when exercising.
Pectus carinatum is not known to cause damage to the lungs or heart, but it can affect body image and self-esteem.
Pectus Carinatum Diagnosis and Treatment
Pectus carinatum is typically diagnosed during a physical examination. To determine the severity of the condition, your medical team might request a series of tests, including an echocardiogram, CT scan or pulmonary function testing.
After making a diagnosis, we will explore a variety of treatment options. In most cases, pectus carinatum patients will not require surgery.
Nonsurgical treatment options could include chest-specific physical therapy and bracing. We use a custom-fitted, ultralight aluminum brace called the FMF® Dynamic Compressor System, which gradually reshapes the chest wall with minimal discomfort. The success rate for the FMF® Dynamic Compressor System is greater than 90 percent when children or adolescents wear it as directed.
To fit a child for a brace, we use a pressure-measuring device to measure the chest wall and determine how much pressure is needed to correct his or her pectus carinatum. We also take measurements of the chest wall to ensure the brace fits perfectly.
Once the brace arrives, we develop a treatment plan that begins with very low-pressure settings. Then, we gradually increase the pressure at each subsequent monthly visit. Once the pectus carinatum is corrected, the patient undergoes a weaning process until the brace is finally discontinued.
If bracing is not effective — or if your child is experiencing severe chest pain — we might recommend surgery. In most cases, we perform a minimally invasive repair of pectus carinatum (MIRPC), where we make two small incisions in your child’s chest and insert a steel bar that pushes his or her cartilage into place.
In rare situations, we would recommend a different technique called the Ravitch procedure, where our surgeons open your child’s chest, remove abnormal cartilage and place the sternum in an appropriate position.
Both of these procedures are performed while your child is under general anesthesia. Sometimes prior to surgery, an anesthesiologist will insert an epidural catheter into your child’s back while he or she is asleep. An epidural is a small tube that allows your child to receive pain medication after surgery.
When your child is awake in the recovery room, our nursing team and anesthesiologist work together to ensure her or she is as comfortable as possible. Your child might receive a combination of intravenous (IV) and oral pain medications after surgery, which could include the epidural or a patient-controlled analgesia (PCA) pump.
For both the MIRPC procedure and the Ravitch procedure, the average hospital stay is four to seven days. Once your child is ready to go home, the IV pain medications are stopped and he or she is transitioned to oral pain medications. Most children will require two to three weeks of oral pain medications after they are discharged.