17328 Pectus Excavatum

Overview

Pectus excavatum, sometimes called 'sunken chest,' is a condition where the breastbone (the flat bone in the middle of the chest) and some ribs grow inward, creating a depression in the center of the chest. It is usually present from birth or becomes more noticeable during rapid growth in the teenage years.

It is fairly common, affecting about 1 in every 400 to 1,000 children. Many people with pectus excavatum have no symptoms and may not even know they have it.

It often appears early in life and becomes more obvious during puberty, when growth is rapid. It affects both sexes, but is more common in males. Some families have more than one member with the condition, which suggests a genetic link.

Symptoms

Common symptoms

• A visible dent or cup-like depression in the middle of the chest
• No symptoms at all for many people
• Chest discomfort or tightness, especially during exercise
• Shortness of breath when active
• A fast or irregular heartbeat, especially after physical activity

Causes

Main causes

• The exact cause is not fully understood, but it is thought to involve abnormal growth of the cartilage that connects the ribs to the breastbone, which pulls the breastbone inward.
• It can run in families, so genes may play a role.
• It may be linked to other conditions that affect connective tissue, such as Marfan syndrome, but in most cases it appears on its own.

Risk factors

• Being male
• Having a family history of pectus excavatum
• Having a connective tissue disorder or certain genetic syndromes

When to see a doctor

See a doctor urgently if:

• Seek urgent care if you or your child have sudden severe chest pain or difficulty breathing.
• Seek urgent care if the chest depression appears to become much deeper over a short period of time.

Book a routine appointment if:

• Make a routine appointment if you are concerned about the shape of your or your child's chest.
• See a doctor if you or your child feel short of breath, have chest pain with exercise, or have trouble keeping up with physical activities.
• Talk to a doctor if the appearance of the chest causes distress, embarrassment, or affects confidence.

Diagnosis

A doctor can usually make the diagnosis by looking at the chest and gently pressing on the area. They will ask about your symptoms, medical history, and whether any family members have the condition.

Tests that may be done

• Chest X-ray
• CT scan (a detailed imaging scan that shows the shape of the chest and how much the heart and lungs are affected)
• Lung function tests (to check how well you breathe in and out)
• Echocardiogram (an ultrasound of the heart to see if it is being pressed on)
• Exercise testing (to see how your heart and lungs respond to activity)

What to expect at your appointment

The doctor may refer you to a specialist, such as a chest (thoracic) surgeon, a cardiologist, or a respiratory specialist, if they think further assessment or treatment might be helpful. You may be asked to have some imaging tests and breathing tests. The results will help you and your doctor decide the best next steps.

Treatment

Treatment is not always necessary. It depends on how much the condition affects your daily life, breathing, or heart function. Many people manage well with regular check-ups and a healthy lifestyle. Surgery may be an option for people with significant symptoms or distress about the appearance of their chest.

Self-care at home

• Stay physically active to keep your chest muscles and lungs strong. Walking, swimming, and cycling are good options.
• Practice good posture to help your chest appear less prominent and to support healthy breathing.
• Talk to a physiotherapist about breathing exercises or chest expansion exercises you can do at home.
• If you smoke, ask your healthcare team for support to quit. Smoking can make breathing problems worse.

Medical treatments

Medical treatment focuses on monitoring symptoms and supporting your breathing and heart function. If breathing problems are severe, oxygen therapy or pulmonary rehabilitation may be offered. There are no medicines that can change the shape of the chest. Corrective surgery is the only way to permanently change the appearance and, in some cases, improve heart and lung function. Surgery techniques include placing a metal bar inside the chest to push the breastbone outward, or removing and reshaping the abnormal cartilage. The type of procedure depends on your age, how severe the depression is, and the surgeon's recommendation.

When is surgery considered?

Surgery may be considered if the depression is severe enough to cause breathing or heart problems, or if it causes significant psychological distress. It is often performed in the teenage years, but adults can also have surgery if they are otherwise healthy. A surgeon will help you weigh the benefits and risks.

Living with this condition

Most people with pectus excavatum live completely normal lives. If you have symptoms, you may need to pace yourself during physical activity and take rest breaks. Regular check-ups with your GP can help monitor any changes. It is also helpful to stay aware of your posture and to practice breathing exercises.

Lifestyle tips

• Keep a healthy body weight to avoid putting extra strain on your chest and back.
• Avoid smoking or vaping to protect your lungs.
• Wear clothes that make you feel comfortable and confident.
• Talk openly with family, friends, or a counselor about any concerns you have about your appearance.

Diet and exercise

A balanced diet helps keep your bones and muscles strong. Exercise, especially swimming and upper-body strength training, can improve posture and breathing capacity. Always warm up before exercise and stop if you feel chest pain or severe breathlessness. speak to a healthcare professional before starting a new exercise program if you are unsure.

Mental health and emotional wellbeing

Some people with pectus excavatum feel self-conscious or embarrassed about the shape of their chest. This can affect confidence, especially in teenagers. It is normal to feel this way, and it is okay to ask for help. Talking to a counselor, psychologist, or your GP can be very supportive. You do not have to cope alone.

Prevention

There is no known way to prevent pectus excavatum because it is usually present from birth or develops during growth. Even though prevention is not possible, you can take steps to maintain good lung and heart health, such as staying active, avoiding smoking, and seeking medical advice early if you notice symptoms.

Screening programmes

There is no routine screening for pectus excavatum. It is usually noticed by appearance or when symptoms develop. If you have a family history of this condition, your GP can help you understand whether your child might be affected and what to look for.

Complications

If left untreated

• Reduced lung capacity, which may cause shortness of breath during physical activity
• Pressure on the heart, which can affect its ability to pump blood efficiently
• Poor posture and back pain due to the chest shape
• Psychological effects such as low self-esteem, anxiety, or body image concerns

Long-term outlook

The outlook for people with pectus excavatum is generally very good. Many people have no symptoms and need no treatment. For those who do have symptoms, surgery has a high success rate in improving both the shape of the chest and any breathing or heart problems. With the right support, most people adapt well and enjoy active, healthy lives.

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