Pectus Excavatum

Chest Wall Deformities

Pectus excavatum is a term for a rib cage that sinks in the front of the body. The sternum, the bone that is in the middle of the thorax, where all ribs interconnect, sits way deeper in the chest than in most people. That gives the rib cage an ‘excavated’ appearance which is the root of the word excavatum. For most people, this is not an issue but some may think that this type of rib cage is not ideal. It can alter the appearance of a person because of the smaller dimensions from the front of the ribs to the back. The cause of this medical problem is not known. Some hypothesize that it is a genetic condition while others argue that it is a random one. Most agree that it is something that occurs during early development and has nothing to do with trauma to the chest.

Each of the true ribs are individually connected in the back of the body to the spine and in the front of the body to the sternum. The false ribs connect in the back to the spine and also connect to another rib in the front. The floating ribs only arise from the spine, and do not connect in the front at all. This allows the entire ribcage to encase the thorax and protect it. Each rib articulates with the spinous process of a vertebrae in the spine. This connection allows for movement of the ribs when a person breathes. The connection of the ribs in the front to the sternum is also slightly movable so that the chest can expand and contract to move air in and out.

In some cases, the connections in the front do not function well in patients with excavatum. This can cause several types of pectus excavatum symptoms. The most prominent is difficult breathing. If the chest is so ‘caved’ in that it is difficult for it to expand and contract, pectus excavatum surgery may be required. This surgery is directed to relieve this limited motion.

Pectus excavatum symptoms may also stem from the reduced space that a sunken chest creates in the body. Because the sternum is so close to the spine, it limits the size of the chest. This prevent proper positioning of the heart and may compress it or have it shift to one side or another. The pressure or malposition of the heart can cause a person to feel short of breath or have other symptoms such as difficulty swallowing.

Pectus excavatum surgery is very difficult. There are very few effective procedure. Most of the time no surgeries are performed because the problem is only superficial. It does not make sense to operate on the chest for a problem that is merely cosmetic. But in specific cases a surgery would be required. Most procedures are very invasive and require placement of metal rods or removal of the sternum. By removing the sternum, the ribs can be pushed into proper position. Implantable metal rods also expand the area over a period of time, allowing the chest to form a more typical shape. Overall, pectus excavatum is not a serious condition but should be treated if symptoms require.