Pectus Carinatum (Pigeon Chest)

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. Pigeon chest 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 teenaged years.

Up to 50 percent 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. For some, symptoms may include: 

• Chest pain during times of accelerated growth and development
• Shortness of breath, especially when exercising.

While pigeon chest 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?

Pectus carinatum is often diagnosed through a physical examination of the chest wall due to its visual appearance.

Depending on the symptoms and clinical findings, additional tests may be ordered, such as:

• Echocardiogram
• Pulmonary function test
• CT scan

How Is Pectus Carinatum Treated?

Initial care may include monitoring the patient’s growth. The care team will consider both conservative treatment options and surgical correction.

Additional treatment options may include:

• Physical therapy evaluation and treatment
• Annual follow-up in the Chest Wall Disorders Clinic

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. Sometime before 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:

• Access and download a handout on “Pain Management Following Surgery”
  • English
  • Español
• Access additional information on "Post-Operative Pain Relief"

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:

• English
• Español

Activity Level - Home

Regarding resuming normal activity, patients are generally advised to abstain from heavy physical exertion for about six 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 two weeks, three months, six months, 12 months, 18 months and at two 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 & 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.