Deformities & tumors of thoracic wall - pectus carinatum

Question 1

Pectus carinatum (“pigeon chest”):

Answer 1

The sternum is pushed outward.
This often causes pain during exercise / increased breathing.

More often in males (4:1 ratio).

Develops later in males.

Often increases in severity with age & worsens during growth spurts that occur during late childhood & adolescence.

Usually does not interfere with heart & lung function.

Question 2

etiology

Answer 2

unknown

Seen in some inherited connective tissue disorders such as Marfan, Ehlers-Danlos & homocystinuria (a metabolic disorder).
When present in infancy, may be linked with premature fusion of sternum segments, ribs & congenital heart disease (Noonan syndrome).

Question 3

clinical presentation

Answer 3

Usually children are asymptomatic.

Some may have trouble playing, exercising & intermittent pain in the area of overgrown cartilages.

Question 4

diagnosis

Answer 4

Chest X-ray during their initial evaluation. This helps the surgeon screen for other chest abnormalities / scoliosis.

A child may also have a chest CT to define the anatomy of the chest.

In severe cases of breathing symptoms, a pulmonary function test may be done to determine the degree of compromise.

ECG & echocardiogram.

Question 5

treatment

Answer 5

External Bracing (Orthotic) Technique:

Conservative: In children > 18 with mild / moderate pectus carinatum & highly motivated to avoid surgery, the use of a custom-fitted chest-wall brace, pushing directly on the sternum, produces excellent outcomes.
Surgery: if external bracing is contraindicated / fails.