Overview
Diagnosis
Diagnosis of pectus excavatum begins with a healthcare professional examining the chest. In many cases, a physical exam is enough to identify the condition. Additional tests may assess how the condition affects the heart and lungs:
• Chest X-ray, to show the sunken breastbone and any heart displacement
• CT scan or MRI, for detailed images of the chest and to check for compression of the heart or lungs
• Electrocardiogram, to evaluate the heart’s rhythm and electrical signals using electrodes placed on the chest
• Echocardiogram, to provide real-time images of heart function and blood flow, and to see if the chest wall affects the heart
• Lung function tests, to measure lung capacity and airflow
• Exercise function test, to assess how the heart and lungs perform during physical activity
These tests help determine the severity of the condition and guide treatment decisions.
Treatment
Treatment for pectus excavatum depends on the severity of symptoms and cosmetic concerns. Mild cases may benefit from non-surgical approaches, while moderate to severe cases often require surgery.
Therapies
Non-surgical treatments for mild pectus excavatum include:
• Physical therapy, to improve posture and chest expansion
• Sternal suction, used in children and young teens, which employs a cup- or bell-shaped device to gently lift the breastbone. This is typically used for 1–15 hours a day over 12–15 months
Surgery or other procedures
Surgical repair is recommended for moderate to severe cases and aims to improve both symptoms and chest appearance. Common surgical approaches include:
• Nuss procedure, a minimally invasive surgery where small chest cuts allow placement of a curved metal bar under the breastbone to raise it. Bars are usually removed after two to three years
• Ravitch technique, an older approach involving a larger chest incision, removal of deformed cartilage, and stabilization of the breastbone with surgical hardware, which is removed after a year or more
Pain management techniques such as cryoablation may be used during surgery to block nerve pain for several weeks.
Cosmetic treatments are also available for mild cases, focusing solely on chest appearance. These include silicone implants or dermal fillers to fill the sunken area.
Most people report satisfaction with the cosmetic results, regardless of the surgical method used.
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