PECTUS EXCAVATUM
Our center offers a unique comprehensive program for the child with
Pectus Excavatum deformity. Through an extensive evaluation, we can assist
in determining the severity of the Pectus deformity from visual,
radiographic, psychologic, and physiologic perspective. Based on the
evaluation, appropriate surgical and non surgical treatment options will be
addressed.
Diagnosis - Surgery - Non Surgical Approaches
What is Pectus Excavatum?
Pectus excavatum is a chest wall abnormality where the sternum (breast
bone) and ribs are depressed inwards (concave) giving the appearance of a
sunken chest. This sunken chest appearance is often recognized at or shortly
after birth (congenital) or may be acquired at a later time. The child may
also have rounded shoulders with their abdomen protruding outwardly or a
“pot belly” appearance as a result of the rib cage “sticking out.”
A pectus excavatum may be caused by an excessive overgrowth of costal
(rib) cartilage, low bone densities, poor nutrition and muscle imbalances.
It is found more often in boys then girls. Pectus excavatum becomes more
noticeable once the child enters periods of rapid growth such as during
early adolescence. It is not uncommon for a child with a pectus excavatum to
also have curvature of the spine (scoliosis), a hunched over posture (kyphosis)
or Vitamin D deficiency (rickets).
Should I be Concerned?
It is easy to see what a pectus excavatum looks like from the outside.
However, we need to know whether the pectus excavatum is causing problems on
the inside.
One of the main functions of the rib cage is to “protect” the lungs and
heart. In people with a pectus excavatum, the rib cage is shaped
differently. Although the heart and lungs are still protected by the ribs,
the concave shape of the rib cage may cause these vital organs to be
compressed. The chest wall may restrict the lungs from expanding properly
interfering with optimal lung growth. This restriction may prevent normal
contractions leading to cardiac limitations.
|
Signs & Symptoms |
- Sunken Chest
- Rounded Shoulders
- Protruding Abdomen
- Scoliosis
- Diagnostic Evaluation
|
Depending on the severity of the chest wall abnormality, the child may
experience restricted function of the heart and lungs. This may become
apparent during times of physical activity when the child may have decreased
endurance and stamina. Some individuals may experience chest pain, cough,
wheezing and recurrent respiratory infection. In addition to bony
abnormalities and possible lung and heart restriction, these children often
become very self-conscious about appearance which may impact their lifestyle
choices.
When the classic signs and symptoms are present, consultation with a
medical team that specializes in the care of children with pectus excavatum
is suggested. This team would include:
- A pulmonologist who specializes in determining the significance of the
chest wall compression on the lungs and heart;
- A physical therapist who can address the consequences of the chest
wall abnormality; and
- A pediatric surgeon who can offer surgical intervention if required.
Proper assessment of this condition includes determining the size of the
lungs, an ECHO (picture of the heart), a chest radiograph and CT, how the
lungs and heart respond to physical stress (an exercise test), and an
assessment of associated muscle function.
|
Diagnostic Evaluation |
- Pulmonary Function Tests
- Chest X-Ray
- Chest CT Sca
- Echocardiogram
- Physical Therapy Assessment
- Exercise Test
|
Treatment may include non-invasive physical retraining and realignment
physical therapy, invasive surgery, or both. Aggressive physical therapy may
have a role in slowing the progression of the chest wall abnormality and may
even reverse some of the cosmetic appearance. Consultation with an
experienced physical therapist with expertise in respiratory disorders can
assist you in this non-invasive approach.
Once it is determined that the pectus excavatum is compromising either
the heart or lungs, surgery should be considered. Currently, the Ravitich
and Nuss procedures as well as use of silicone implants are available.
The Ravitich procedure is the most commonly used method although all are
performed. The Ravitich procedure consists of lifting up the chest muscles,
resecting the costal cartilage, rotating the sternum to lie flat and
inserting a bar inside. Most patients are very satisfied with this procedure
with very low recurrence rates.
The Nuss procedure is a newer and minimally invasive surgery where two
small incisions are made on each side of the chest with a curved steel bar
inserted behind the ribs to force the sternum outward to the correct shape.
After two years when the desired shape of the chest has formed, the bar is
them removed. This procedure is quicker and offers faster recovery.
The decision of which procedure to undergo is dependent on both the needs
of the child and the experience of the pediatric surgeon. Sometimes surgery
is performed for cosmetic or psychological reasons. Some insurance companies
do not cover this type of “elective” surgery. Asking questions of the health
care team will assist you in finding the best procedure for your child.
Summary
Pectus excavatum is a bony deformity of the rib cage that can be present
at birth or later in childhood. Proper diagnosis and assessment is essential
to determining if the deformity is harming underlying heart and/or lungs.
Surgery is necessary in some cases. Physical therapy may effectively reduced
physical limitations in some cases. Consultation with medical specialists
experienced with all aspects of pectus excavatum care is your best approach
in addressing the multiple challenges that this condition may impose.
|
