15790 Pectus Carinatum

Overview

Pectus carinatum is a condition where the breastbone (the flat bone in the middle of the chest) sticks out more than usual. This can make the chest look like a bird's breast or a boat keel, which is why it is sometimes called 'pigeon chest' or 'keel chest.' It happens when the cartilage that connects the ribs to the breastbone grows unevenly. In many cases, it is harmless and does not cause health problems, but it can affect how a person feels about their body.

Pectus carinatum is less common than its opposite condition, pectus excavatum (sunken chest). It affects about 1 in every 1,000 children, though mild cases may not be counted.

It is more common in boys than girls, and it often becomes noticeable during the growth spurt of puberty. It can run in families, and it sometimes appears alongside other conditions, but many people with pectus carinatum are otherwise completely healthy.

Symptoms

Common symptoms

• The breastbone visibly protrudes outward, sometimes more prominent on one side.
• The chest may feel firm or hard when pressed.
• Some people have mild chest discomfort or pain, especially after exercise.
• In more severe cases, there may be shortness of breath during physical activity.
• Some people feel self-conscious about the shape of their chest.

Symptoms in children

• In younger children, the protruding breastbone might be noticed as an asymmetry in the chest.
• It often becomes more obvious during the adolescent growth spurt.
• Children may not report any symptoms, but may feel embarrassed when changing clothes or swimming.

Symptoms in older adults

• In adults, the chest shape is usually fixed, and symptoms are often mild or absent.
• If the condition is severe, arthritis or stiffness of the chest wall may develop over time.
• Breathing problems are rare but can occur if the chest wall movement is restricted.

Causes

Main causes

• Abnormal growth of the cartilage that connects the ribs to the breastbone, causing the breastbone to be pushed forward.
• Genetics — the condition can run in families, so there is likely a hereditary component.
• Sometimes it occurs as part of a syndrome, such as Marfan syndrome or other connective tissue disorders.

Risk factors

• Being male — boys are affected more often than girls.
• Having a family history of pectus carinatum or similar chest wall differences.
• Rapid bone growth during puberty, which can make the chest shape more noticeable.
• Having certain connective tissue disorders or genetic conditions.

When to see a doctor

See a doctor urgently if:

• If you or your child experience sudden chest pain or breathing difficulty.
• If the chest becomes painful, red, or swollen over the protruding area.
• If you notice a rapid change in the shape of the chest, especially with pain.

Book a routine appointment if:

• If you are concerned about the appearance of the chest, even if there are no symptoms.
• If chest pain or shortness of breath occurs during exercise or sports.
• If the condition seems to be getting more pronounced over time and is causing worry.

Diagnosis

A doctor can usually diagnose pectus carinatum by looking at the chest and gently pressing on the breastbone. They will ask about symptoms, family history, and any changes over time. In most cases, no tests are needed, but imaging may be used if the doctor wants to check the severity or look for other conditions.

Tests that may be done

• Chest X-ray — a simple picture of the chest to see the shape of the ribs and breastbone.
• CT scan — a more detailed picture that can measure the chest shape and check the lungs and heart.
• Pulmonary function tests — breathing tests to see how well the lungs are working, if there are breathing symptoms.

What to expect at your appointment

The doctor will ask about your medical history, do a physical exam, and may suggest observations over time. If the condition is mild and not causing symptoms, the doctor may simply recommend regular check-ups. If there are concerns about breathing, heart function, or self-esteem, they may refer you to a chest specialist or a surgeon who deals with chest wall conditions.

Treatment

Treatment for pectus carinatum depends on the severity of the chest shape, the age of the person, and whether there are any physical or emotional symptoms. For many people, no treatment is needed, and the condition is simply monitored. When treatment is considered, it usually involves either bracing, exercises, or surgery.

Self-care at home

• Maintain good posture — sitting and standing straight can improve the appearance of the chest.
• Stay physically active — exercise helps keep the chest and back muscles strong, which can improve breathing and posture.
• Use a well-fitting backpack or avoid heavy slouching to reduce pressure on the chest.
• Talk about any body image concerns with a trusted adult, friend, or support group.

Medical treatments

If the condition is moderate and the person is still growing, a chest brace may be used. The brace applies gentle pressure to the protruding breastbone over a period of months to help reshape the chest. Physical therapy may also be recommended to strengthen the chest and back muscles. In some cases, a doctor may refer the person to a specialist service for custom bracing or other non-surgical approaches. Medications are not used to treat the chest shape itself.

When is surgery considered?

Surgery is usually considered only for severe pectus carinatum that causes significant physical symptoms, such as breathing problems or chest pain, or when bracing has not worked and the person is bothered by the appearance. The operation involves reshaping the breastbone and cartilage, and it is usually done by a specialist chest surgeon.

Living with this condition

Most people with pectus carinatum live active, healthy lives. The chest shape may change a little during growth, but it usually becomes stable after puberty. It is important to focus on overall health, posture, and confidence rather than the shape of the chest.

Lifestyle tips

• Stay active — swimming, running, and sports can help keep your lungs and heart healthy.
• Practice good posture — shoulders back and down can make the chest look flatter.
• Wear comfortable clothing — loose or stretchy clothing can feel more comfortable and less noticeable.
• If bracing is recommended, follow the doctor's instructions consistently.

Diet and exercise

A balanced diet supports healthy bones and muscles. Regular exercise, including deep breathing activities like swimming or yoga, can improve chest expansion and posture. You do not need to avoid physical activity because of pectus carinatum unless a doctor has advised you otherwise.

Mental health and emotional wellbeing

Some people feel embarrassed or self-conscious about the shape of their chest, especially during teenage years. This is normal, but it is important to know that pectus carinatum does not define who you are. Talking to a counsellor or psychologist can help if you are struggling with body image, and support groups can connect you with others who understand what you are going through.

Prevention

Pectus carinatum cannot be prevented, because it is due to the natural growth pattern of the chest cartilage and bones. However, early detection during routine check-ups can help if treatment is needed. There is no known way to stop it from developing.

Complications

If left untreated

• Severe pectus carinatum can, in rare cases, reduce the space for the lungs and heart to expand, leading to shortness of breath or tiredness during exercise.
• Some people may develop pain or stiffness in the chest wall as they get older.
• Body image concerns may affect self-esteem and mental health.

Long-term outlook

The outlook is generally very good. Many people with pectus carinatum never need any treatment, and the condition does not shorten life expectancy. For those who do need treatment, bracing or surgery can greatly improve both the appearance and any physical symptoms. It is possible to live a full, active, and happy life with pectus carinatum.

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