Pectus carinatum, often referred to as “pigeon chest,” is a common chest wall deformity where the sternum and associated costal cartilages protrude outward. This condition affects approximately one in 1,000 children and is more frequent in males. While the visible protrusion may cause anxiety and self-consciousness, pectus carinatum is generally not considered life-threatening. This article explores the physical risks, underlying causes, and management options for the condition.
Understanding Pectus Carinatum and Physical Risks
Pectus carinatum is characterized by an abnormal outward growth of the breastbone and ribs, creating a distinctive convex shape. This occurs because the cartilage connecting the ribs to the breastbone grows excessively, pushing the sternum forward. Most individuals with this chest wall protrusion remain asymptomatic, meaning the condition does not usually compromise major organ function.
In more severe cases, restricted movement of the chest wall can lead to mild physical symptoms, such as chest wall pain, tenderness, or shortness of breath during vigorous physical exercise. The outward growth can sometimes be asymmetric, or in rare instances, one side may protrude while the other is sunken. Some patients may also have a heart murmur or mitral valve prolapse. Life-threatening complications from the chest protrusion itself are rare, and the condition does not adversely affect life expectancy.
Addressing the Underlying Causes and Diagnosis
The exact mechanism causing the ribs and sternum to grow abnormally remains largely unknown, but it is believed to be related to excessive growth of the costal cartilage. A genetic component is strongly suspected because the condition tends to run in families; up to one-third of people with pectus carinatum have a family member with a chest wall issue. The deformity often becomes more noticeable during adolescence, particularly during rapid growth spurts between the ages of 11 and 14. Pectus carinatum may also be associated with connective tissue disorders, such as Marfan syndrome or Ehlers-Danlos syndrome, or musculoskeletal issues like scoliosis.
Diagnosis typically begins with a physical examination, as the protrusion is readily visible. A medical professional assesses the severity and determines if the chest is flexible enough for non-surgical treatment options. Imaging tests, such as chest X-rays or a Computed Tomography (CT) scan, are used to accurately measure the degree of protrusion and screen for underlying cardiac or pulmonary concerns. An echocardiogram may also be recommended to check for associated heart conditions.
Treatment Pathways and Non-Physical Impact
Management depends on the patient’s age, the severity of the protrusion, and the flexibility of the chest wall. For mild cases in young children or those with minimal symptoms, the standard approach is observation. Since the chest wall is more pliable during growth, early intervention tends to yield the best results.
The primary non-surgical treatment is the use of an external compression brace for patients whose chests are still flexible. This custom-fitted orthotic applies continuous, targeted pressure to the protruding areas of the sternum and ribs. The brace gradually reshapes the cartilage over a period of months to a year, with success rates reported to be over 90% for compliant patients.
Surgical intervention is typically reserved for severe, rigid deformities, or cases where bracing has failed to achieve correction. Procedures, such as the Modified Ravitch technique, involve removing the overgrown cartilage and repositioning the sternum. Surgery is considered a last resort due to its complexity and recovery time.
For many individuals, the most significant challenge associated with pectus carinatum is not physical, but psychological and social. The visible difference in chest shape often leads to body image concerns and increased self-consciousness, particularly during the adolescent years. This can manifest as anxiety, reduced self-esteem, and social isolation, sometimes causing individuals to avoid activities like swimming or sports. Treatment, whether bracing or surgery, has been shown to improve a patient’s self-esteem and overall quality of life by addressing the cosmetic and psychological burden of the condition.