Pectus carinatum, also called a protruding sternum or pigeon chest, is a rare deformity in children. It causes the chest and ribs to stick out further than they should. Only one or two children out of every thousand have a protruding sternum. This condition usually affects more boys than it does girls.
What Is Pectus Carinatum?
Pectus carinatum is a deformity of the chest wall. The cartilage between the ribs and the breastbone, or sternum, grows too much, causing the middle of the chest to point out. The protruding sternum becomes more noticeable during puberty as children go through a growth spurt. In fact, 90% of all cases of pectus carinatum are diagnosed after age 11.
Pectus carinatum is also called pigeon chest because of the way it makes the chest stick out, appearing like a bird or pigeon.
Pectus carinatum doesn’t stop until the bones stop growing, usually around age 18. Because of this, it can cause your child to feel self-conscious in social situations, like when they are swimming or have to change clothes in front of others.
What Are the Symptoms of a Protruding Sternum?
Children and teens with a protruding sternum may experience:
- Chest pain
- A quick heartbeat (tachycardia)
- Shortness of breath, especially while exercising
- Feeling tired or fatigued
Pectus carinatum doesn’t usually do any harm to the internal organs. Some children may have pectus carinatum on one side of the chest more than the other, so the chest appears uneven.
What Are the Causes of Pectus Carinatum?
The cause of pectus carinatum is unknown, but the condition sometimes affects several members of the same family.
Doctors have noticed that children who have pectus carinatum often have another health condition that goes along with it. Some of the most common include:
- Down syndrome: a genetic disorder caused by an extra copy of chromosome 21
- Marfan syndrome: a connective tissue disorder
- Morquio syndrome: unusual growth of the bones or tissue that can cause dwarfism
- Edwards syndrome: a genetic disorder caused by an extra copy of the 18th chromosome
- Osteogenesis imperfecta: a disease that causes bones to be fragile or brittle
- Multiple lentigines syndrome: a genetic disorder that causes skin abnormalities
How Is Pectus Carinatum Diagnosed?
To diagnose your child, your doctor will first look at their chest. They will give your child a physical exam and measure the chest wall. Most doctors will also perform an X-ray to get a look at your child’s chest from both the front and the side. This helps to get an idea of how serious the protruding sternum is.
Your doctor may order more tests to check for other conditions. Some common tests to help diagnose pectus carinatum include:
- Scans like computed tomography (CT) or magnetic resonance imaging (MRI)
- Electrocardiogram (EKG) or echocardiogram to get an image of the heart
- Scoliosis test
- Pulmonary function test to check the lungs
- Genetic testing to check for any syndromes that may be related to pectus carinatum
How Is Pectus Carinatum Treated?
Most people don’t need treatment for pectus carinatum, but there are options for those who feel self-conscious about it, or if it affects another condition.
The most common pectus carinatum treatment is the use of compression braces. These braces gradually realign the chest over time by applying slight pressure. The compression braces are worn around the chest to help reshape it.
Keep in mind that for compression braces to have an effect, children should wear them between 16 and 20 hours a day. During that time, your child’s doctor will monitor their progress to see how the braces are working. These orthotic braces are fitted individually to the wearer to make sure they have the best chance of working.
For people with a mild case, easy weightlifting can increase the muscle mass in the chest, which can help fill in the shape of the chest.
Only severe cases of pectus carinatum require surgical treatment. This treatment is called a Ravitch procedure to remove excess cartilage. To do so, your doctor will make a small cut in the middle of your child’s chest to remove cartilage from the front of the breastplate. The cartilage should regenerate in a few weeks.