What is Pectus Excavatum?
Pectus excavatum (PE) is an abnormal development of the rib cage, in which the breastbone caves in, causing the chest to “sink” inward.This developmental abnormality often presents at birth, and can be mild or severe. Although the sunken chest wall deformity is most common in the middle of the chest, it may move to one side of the chest, usually the right.
Pectus excavatum occurs more often in men than women, appearing in 1 per every 300 to 400 white male births.
Most patients do not have symptoms, though a minority of patients may have the following symptoms:
- Shortness of breath/decreased exercise tolerance
- Chest pain
- Fast heart rate (tachycardia)
The causes of pectus excavatum are not well understood. It is thought that the deformity is due to excessive growth of the connective tissue that joins the ribs to the breastbone. This excessive growth may subsequently cause an inward defect of the sternum. If there is uncoordinated growth between the ribs and the chest, the ribs may grow faster than the expansion of the heart and lungs (which normally pushes the sternum outward), resulting in the sternum being pushed inward.
There are certain disorders associated with pectus exacavatum including:
- Marfan Syndrome
- A connective tissue disorder, which causes skeletal defects.
- Is typically recognized by long limbs and ‘spider-like’ fingers, chest abnormalities and spine curvature.
- Due to a lack of vitamin D or calcium and from inadequate sunlight exposure, which destroys normal bone growth.
- This primarily occurs in children
- This is the curvature of the spine
- Complete Physical Exam
- Comprehensive Blood Tests, such as chromosome studies or enzyme assays
- Physical (stress) Tests
- Chest x-ray
- CT scan of the chest
- Electrocardiogram (EKG)
- Echocardiogram (picture of the heart)
Since most patients with pectus excavatum do not have symptoms, treatment may not be needed, or will be dependent upon the development of symptoms.
If pectus excavatum is compromising to either the heart or lungs, your doctor may recommend surgery.
Surgery: The primary goal of pectus excavatum repair surgery is to correct the chest deformity to improve a patient’s breathing, posture and cardiac function. Removing a portion of the deformed cartilage and re-positioning the breastbone typically accomplishes this. Repair of pectus excavatum is not recommended unless the patient has symptoms.
- Risks of Surgical Repair Pneumothorax (accumulation of air or gas in the pleural space)
- Pleural effusion (fluid around the lungs)
- Pectus excavatum recurrence
The chest cavity contains vital organs and is protected by a bony rib cage. The ribs are connected to each other by several layers of muscles, which assist with breathing.
Fractured ribs (also known as cracked ribs), usually occur as a result of blunt chest wall trauma or lifestyle injuries that range from cycling to football. Fractured ribs may heal on their own without treatment. However, some patients have rib fractures in which bone fragments can damage major blood vessels, or structures like the lung, liver, kidneys or spleen. In these cases, rib fractures usually require treatment.
Symptoms of a rib fracture may include pain with the following actions:
- Taking a deep breath
- Pressing on the injured area
- Bending or twisting your body
The following factors may increase your risk of a having a rib fracture:
- Osteoporosis – this disease decreases the density of your bones, making your rib more sensitive to fractures.
- Playing sports
- Having an area of cancer in your rib – cancer may weaken the bone, making your rib more sensitive to fractures.
- X-Ray: Rib fractures are typically diagnosed on chest x-ray and the severity of the fracture is easily seen.
- CT Scan: CT scans may show rib fractures that were not visible on an X-ray. Injuries to blood vessels and soft tissues are easier to see on a CT scan than an X-ray.
- MRI: An MRI can also look at the organs and soft tissues around the ribs to detect damage to these areas.
Most non displaced fractured ribs heal without surgery in one to two months and are treated with non-surgical care that ranges from aggressive pain management to proper ventilation.
For patients with displaced fractures, flail segments, or high narcotic requirement surgical treatment with rib plating may be required along with aggressive pain management and proper ventilation.