Pectus Excavatum

Pectus excavatum, often referred to as "funnel chest," is a structural deformity characterized by a sunken appearance of the chest. This condition can lead to both physical and psychological discomfort, affecting an individual's quality of life. 

What is Pectus Excavatum?

Pectus excavatum is a congenital deformity where the breastbone (sternum) is sunken into the chest. This abnormality can vary in severity, ranging from mild to severe cases where the sternum almost touches the spine. While the exact cause is not well understood, it is believed to involve genetic and environmental factors.

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Causes of Pectus Excavatum

Genetic Factors

Pectus excavatum often runs in families, suggesting a genetic component. Mutations in certain genes that affect cartilage and bone development may play a role. However, no specific gene has been identified as the sole cause.

Connective Tissue Disorders

Conditions such as Marfan syndrome and Ehlers-Danlos syndrome have been associated with pectus excavatum. These disorders affect the body's connective tissues, including cartilage and bone, which can contribute to the development of this chest deformity.

Intrauterine Factors

Some studies suggest that abnormal fetal development, possibly due to intrauterine pressure or other environmental factors, might contribute to the formation of pectus excavatum.

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Symptoms and Diagnosis

Physical Symptoms

The primary symptom of pectus excavatum is the sunken appearance of the chest. However, the condition can also lead to respiratory and cardiovascular issues. Symptoms may include:

Psychological Impact

The cosmetic appearance of pectus excavatum can lead to psychological issues such as anxiety, depression, and social withdrawal, particularly in adolescents and young adults.

Diagnostic Methods

Physical Examination

A physical examination by a healthcare provider is usually the first step in diagnosing pectus excavatum. The doctor will assess the severity of the chest indentation and check for any associated symptoms.

Radiology

Radiological imaging, such as chest X-rays and CT scans, are essential for diagnosing pectus excavatum. These imaging techniques help determine the extent of the deformity and its impact on the heart and lungs.

Pulmonary Function Tests

Pulmonary function tests measure how well the lungs are working. These tests can help determine if pectus excavatum is affecting respiratory function.

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Treatment Options for Pectus Excavatum

Non-Surgical Treatments

Physiotherapy

Physiotherapy can help improve posture and strengthen the chest muscles, which may alleviate some symptoms of pectus excavatum. Exercises focusing on breathing techniques and muscle strengthening are often recommended.

Vacuum Bell Therapy

Vacuum bell therapy involves using a suction cup device to elevate the sternum. This non-invasive treatment is usually recommended for younger patients with mild to moderate deformities.

Surgical Treatments

Nuss Procedure

The Nuss procedure is a minimally invasive surgery that involves placing a curved metal bar under the sternum. The bar is inserted through small incisions on the sides of the chest and is used to elevate the sunken sternum. The bar is typically left in place for two to three years before being removed.

Ravitch Procedure

The Ravitch procedure is a more invasive surgery that involves removing cartilage and repositioning the sternum. This procedure is often reserved for severe cases or when the Nuss procedure is not feasible.

Post-Surgical Care

Post-surgical care is crucial for a successful outcome. Patients are usually advised to avoid strenuous activities for several months and to follow a physiotherapy regimen to ensure proper healing and chest function.