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Pectus Carinatum

What is pectus carinatum?

Pectus carinatum, also known as pigeon chest, is when the cartilage grows up and out, which causes the sternum, or breastbone, to protrude out in front of the rest of the chest. One or both sides of the chest can be affected. 

Who is affected by pectus carinatum?

This condition is less common than pectus excavatum. It seems to be more prevalent in boys than girls, and is often most evident after a growth spurt when the child is in their pre-teen to early teen-aged years.

Up to 50% of children with a pectus carinatum condition will have a close relative with a similar chest wall abnormality.

What are the symptoms of pectus carinatum?

Most children with this condition do not experience symptoms, but for some there may be chest pain during times of accelerated growth and development. Other children sometimes experience shortness of breath, especially when exercising. While the condition does not cause any known damage to the lungs or heart, psychological impact does affect the child’s body image and often self-esteem.

How is pectus carinatum diagnosed?

Because of the visual nature of this condition, pectus carinatum can usually be initially diagnosed by physical examination of the chest wall. Depending on the symptoms and clinical findings, the medical team may request a series of tests including echocardiogram, pulmonary function test or CT scan.

How is pectus carinatum treated?

Although the initial care may include monitoring a patient’s growth, surgical correction may be provided. The team will look at conservative treatment options, as well as surgery. Some other options may include physical therapy evaluation and treatment, as well as an annual follow-up in the Chest Wall Deformities Clinic.

Go to the Chest Wall Deformity Clinic page for more info on the possible tests.

Non-Surgical Options

Pectus carinatum may be effectively treated with conservative measures such as bracing or physical therapy. If this is an option for your child, you will be given a referral for evaluation and treatment by Physical Therapy and Orthotics teams.

The brace consists of front and back compression plates that are anchored to aluminum bars. The bars are connected to adjustable straps on both sides. The brace is hidden under regular clothing. The amount of time the brace should be worn is dependent on the severity and flexibility of the pectus condition, and can vary from night only to 8 to 20 hours per day.

 

Surgical Options

For patients with pectus carinatum, surgery is not usually required. It is only considered if bracing is not effective, or if the patient is experiencing severe chest pain related to the abnormal growth of their chest wall.

If your child is an appropriate candidate for surgery, it is likely they will have the Ravitch procedure.

With the Ravitch procedure, the surgeon will make an incision to remove abnormal cartilage and place the sternum in the appropriate position.

After surgery, what should you expect?

Hospital stay

For the Ravitch procedure, the average hospital stay is four to seven days.

Pain Management

The surgery for pectus carinatum is done under general anesthesia. Sometimes prior to surgery, an anesthesiologist may insert an epidural catheter into the back while your child is asleep. An epidural is a small tube that will allow your child to receive pain medication after surgery.

The teams at Lurie Children’s care very much about the comfort of patients after surgery and do everything possible to minimize any discomfort that can occur. After your child is awake and is in the recovery room, the recovery room nurse and the anesthesiologist work together to ensure that the child is as comfortable as possible.

Your child may receive a combination of Intravenous (IV) and oral pain medications after surgery. This may include the epidural or patient-controlled analgesia (PCA) pump.

Once your child is ready, the IV pain medications are stopped and your child will be transitioned to a combination of oral pain medications in preparation for discharge home. Most children will require two to three weeks of oral pain medications after they are discharged from the hospital.

Below are two additional resources on pain management:

Wound Care – Hospital and Home

It is important to take very good care of the surgical site until it is fully healed.

Access and download instructions on pediatric surgery postoperative wound care:

Activity Level - Home

In terms of resuming normal activity, patients are generally advised to abstain from heavy physical exertion for about 6 weeks. This also means, no backpacks on the shoulder for three months so the area is not stressed.

They can return to very light aerobic activity, including walking and doing breathing exercises, within six weeks after surgery. No running, working out, sit-ups or biking to protect the area.

After six weeks, patients can begin stronger cardiovascular conditioning such as running, swimming, biking, pilates or yoga.

Other activity restrictions may be similar to those applied after a Ravitch procedure for pectus excavatum.

Post-operative Follow-up

Routine post-surgical follow-up with your pediatric surgeon and team is important and should be done following surgery at 2 weeks, 3 months, 6 months, 12 months 18 months, and at 2 years. Please call the Division of Pediatric Surgery directly to make your appointments: 312.227.4210. These appointments can be made for either our Northbrook or Lurie Children’s downtown locations:

Outpatient Center in Northbrook
1131 Techny Road
Northbrook, IL 60062

Ann and Robert H. Lurie Children’s Hospital of Chicago
225 E. Chicago Ave.
Chicago, IL 60611

Between appointments, seek medical attention if you have any of the following symptoms: chest pain, shortness of breath, persistent cough, fevers greater than 101.5F, pain unrelieved by oral medications, constipation or other concerns.