Pectus Excavatum

What is pectus excavatum?

Pectus excavatum is a condition in which the breastbone (sternum) and some of the ribs grow inward, creating a sunken or caved-in appearance in the center of the chest. The name comes from Latin and roughly means “hollowed chest.” It is sometimes called funnel chest or sunken chest. Pectus excavatum is generally considered the most common structural difference in the shape of the chest wall that people are born with.

The chest wall is made of the breastbone, the ribs, and the flexible cartilage (firm connective tissue) that joins the ribs to the breastbone. In pectus excavatum, this cartilage appears to grow unevenly, pushing the breastbone backward toward the spine. The depression may be shallow and barely noticeable, or deep enough to press on the heart and lungs.

The condition is usually present at birth or becomes noticeable in early childhood. It affects boys more often than girls. In many children the dent stays mild and stable, but in others it becomes more pronounced during the rapid growth of puberty. Pectus excavatum can occur on its own or alongside other conditions that affect connective tissue or the spine.

Pectus excavatum is different from pectus carinatum, in which the breastbone sticks outward rather than inward. Both are chest wall differences, but they are assessed and managed differently. In hospital settings, pectus excavatum is commonly evaluated by a chest wall or thoracic surgery team; at Acibadem this falls under the Thoracic Surgery Department.

Pectus excavatum symptoms

Many people with a mild form have no physical symptoms at all, and the main concern is the appearance of the chest. When the depression is deeper, it can reduce the space available for the heart and lungs. This may cause symptoms that often become more noticeable in the teenage years or during physical activity.

Common pectus excavatum symptoms may include:

• A visible dent or hollow in the center of the chest
• Shortness of breath, especially during exercise
• Reduced tolerance for exercise or tiring more quickly than peers
• Chest pain or discomfort, often described as aching or pressure
• A fast or pounding heartbeat (palpitations)
• Fatigue
• Dizziness or lightheadedness during exertion in some cases
• A wheezing or whistling sound when breathing in some individuals
• More frequent chest infections in some children

The way symptoms develop can differ by stage and severity:

• Infancy and early childhood: The dent is often noticed by parents or a pediatrician. Physical symptoms are uncommon at this stage, and many children are active and otherwise healthy.
• Adolescence: The growth spurt of puberty can deepen the depression. This is when symptoms such as breathlessness and exercise intolerance are most often reported, and when self-consciousness about appearance may become a concern.
• Adulthood: The chest wall becomes less flexible after growth stops. Symptoms usually stabilize, but some adults report new or worsening breathlessness, chest discomfort, or palpitations later in life.

It is also common for pectus excavatum to affect posture. Some people develop rounded shoulders, a forward-leaning head, or a slightly protruding abdomen. Emotional effects, such as embarrassment about the chest shape or avoidance of swimming and sports, are real and are considered part of the overall picture when doctors assess the condition.

Causes and risk factors

The exact pectus excavatum causes are not fully understood. The leading explanation is that the cartilage connecting the ribs to the breastbone grows too quickly or unevenly. This overgrowth pushes the breastbone inward. Why this happens in some children and not others is still being studied.

Factors that are thought to be linked to pectus excavatum include:

• Genetics: The condition often runs in families. Having a parent or sibling with pectus excavatum or another chest wall difference appears to increase the likelihood, although no single gene has been confirmed as the cause in most cases.
• Male sex: Boys are affected more often than girls.
• Connective tissue disorders: Conditions that affect the body’s supporting tissues, such as Marfan syndrome (a disorder affecting the heart, eyes, and skeleton) and Ehlers-Danlos syndrome (a group of disorders causing very flexible joints and stretchy skin), are more commonly associated with pectus excavatum.
• Other genetic syndromes: Pectus excavatum is seen more often in people with certain syndromes, including Noonan syndrome and Turner syndrome.
• Scoliosis: A sideways curvature of the spine occurs alongside pectus excavatum more often than would be expected by chance.
• Rickets: In rare cases, severe vitamin D deficiency during childhood can contribute to chest wall changes.

It is important to know that pectus excavatum is not caused by anything a parent did or did not do during pregnancy, and it is not caused by poor posture, injury, or a child’s activity levels. Posture can affect how the chest looks, but it does not create the underlying structural change.

Diagnosis

Pectus excavatum diagnosis usually begins with a physical examination. In many cases the shape of the chest is obvious to the doctor. However, additional tests are often used to measure how deep the depression is, to check whether the heart and lungs are affected, and to rule out related conditions. The results help guide decisions about whether treatment is needed.

Tests your doctor may recommend include:

• Physical examination: The doctor looks at the chest, measures the depth of the depression, checks posture and the spine, and listens to the heart and lungs.
• Chest X-ray: A simple image that shows the position of the breastbone and ribs and whether the heart appears displaced.
• CT scan (computed tomography): A detailed cross-sectional scan of the chest. It is commonly used to calculate the Haller index, a measurement that compares the width of the chest with the distance between the breastbone and the spine. A higher number indicates a deeper depression. Doctors often use this index, along with symptoms, to describe severity.
• MRI (magnetic resonance imaging): Sometimes used instead of CT, particularly in children, because it does not involve radiation and can provide similar measurements.
• Echocardiogram: An ultrasound of the heart. It shows whether the heart is being compressed or shifted and checks the heart valves, which can be affected in some people with connective tissue disorders.
• Electrocardiogram (ECG): A recording of the heart’s electrical activity, used to look for rhythm changes.
• Pulmonary function tests: Breathing tests that measure how much air the lungs can hold and how well air moves in and out.
• Exercise testing: In some cases, doctors measure heart and lung performance during exercise, since symptoms are often present only with exertion.

If a connective tissue disorder is suspected, your doctor may also refer you to a genetics specialist or recommend an eye examination, since some of these conditions affect the eyes.

Treatment options

Pectus excavatum treatment depends on the depth of the depression, the presence of symptoms, the person’s age, and how much the condition affects daily life. Not everyone needs treatment. Doctors generally recommend the least invasive approach that meets the individual’s needs.

Observation. For mild cases with no symptoms, regular check-ups may be all that is needed. Children are often monitored through puberty, because this is the period when the chest shape is most likely to change.

Physical therapy and exercise. Exercises that strengthen the back and chest muscles and improve posture may help some people feel and look better. These exercises do not correct the bone and cartilage structure, but they can improve the overall appearance of the chest and may help with breathing mechanics. A physical therapist can design a safe program.

Vacuum bell therapy. A vacuum bell is a suction device placed over the depression. It uses gentle negative pressure to lift the breastbone forward. It is typically worn for a period each day over many months or longer. It tends to work best in younger people whose chest walls are still flexible and in those with a shallower depression. Results vary, and your doctor can help decide whether it is a suitable option.

Surgery. Surgery may be considered when the depression is deep, when there are symptoms affecting the heart or lungs, or when the appearance causes significant distress. It is most often performed during the teenage years, but it can also be done in adults. The two main procedures are:

• Nuss procedure: A minimally invasive operation in which one or more curved metal bars are inserted through small cuts on the sides of the chest and positioned behind the breastbone to push it forward. The bars are usually left in place for a few years while the chest reshapes, and are then removed in a second, shorter operation.
• Ravitch procedure: An open operation in which the surgeon makes a cut across the front of the chest, removes the abnormally shaped cartilage, and repositions the breastbone. A support bar or plate may be used temporarily.

Both approaches have benefits and risks, including pain, infection, bar movement, and the need for follow-up surgery. Your surgical team will discuss which option fits your anatomy and goals. Pain management after surgery is an important part of care; techniques such as nerve blocks and cryoablation (temporarily freezing the nerves between the ribs to reduce pain signals) may be used in some centers.

Medication. There is no medication that corrects pectus excavatum. Medicines are used mainly for pain relief after surgery or, in some cases, to manage related issues such as asthma-like symptoms if they are present.

Rehabilitation. After surgery, a gradual return to activity is usually advised. Contact sports and heavy lifting are often restricted for a period while healing takes place. Breathing exercises and posture work are commonly recommended during recovery.

Living with pectus excavatum and outlook

For most people, pectus excavatum is not life-threatening. Many live full, active lives with no treatment at all. When the condition does cause symptoms, treatment often improves breathing, exercise capacity, and appearance, although results differ from person to person and no procedure can guarantee a specific outcome.

Children and teenagers with pectus excavatum often benefit from regular follow-up so that changes during growth can be tracked. Staying physically active is generally encouraged unless a doctor advises otherwise, and many people find that sports and posture-focused exercise help both physically and emotionally.

The emotional impact should not be underestimated. Feeling self-conscious about the chest is common, especially during adolescence. Talking openly with a doctor about these feelings is appropriate, and counseling or peer support may be helpful for some.

After surgery, most people return to normal activities within a few months, though timelines vary. If a bar has been placed, follow-up visits are needed until it is removed. Long-term results after successful correction are generally considered stable once growth is complete, but a small number of people may experience some recurrence or need further care.

Frequently asked questions

Is pectus excavatum dangerous?

In most cases, pectus excavatum is not dangerous. Mild forms usually cause no health problems. In more severe cases, the sunken breastbone can press on the heart and lungs, which may lead to breathlessness, reduced stamina, or heart rhythm changes. Whether it poses a health concern depends on its depth and on how the heart and lungs are functioning, which is why doctors often recommend an evaluation.

What are the first pectus excavatum symptoms parents usually notice?

The first sign is almost always the appearance of a dent in the center of the chest, often noticed in infancy or early childhood. Physical symptoms are uncommon in young children. If symptoms develop, they usually appear during the teenage growth spurt and may include getting out of breath more easily than other children, chest discomfort, or tiring quickly during sports.

Can pectus excavatum get worse over time?

It can. The depression often deepens during puberty, when the body grows rapidly. After growth is complete, the shape usually becomes stable, although some adults report gradual changes in symptoms over the years. Regular monitoring during childhood and adolescence helps doctors identify whether the condition is progressing.

How is pectus excavatum diagnosis confirmed?

A doctor can usually recognize pectus excavatum by examining the chest. To measure severity and assess effects on the heart and lungs, doctors commonly use a CT scan or MRI to calculate the Haller index, along with an echocardiogram, an electrocardiogram, and breathing tests. These results, combined with symptoms, help determine whether treatment is advisable.

Is surgery the only pectus excavatum treatment?

No. Surgery is one option among several. Many people are managed with observation alone. Physical therapy and posture exercises may help appearance and function, and vacuum bell therapy can lift the breastbone in some people, particularly younger ones with a flexible chest. Surgery is generally considered when the depression is deep, symptoms are significant, or non-surgical approaches have not been effective.

What causes pectus excavatum to run in families?

The exact reason is not fully understood. Researchers believe that inherited differences in how the rib cartilage grows play a role, since the condition is more common in people who have a close relative with a chest wall difference. In some families, an underlying connective tissue disorder such as Marfan syndrome contributes. Genetic testing may be suggested if such a condition is suspected.

Can adults have pectus excavatum corrected?

Yes. Although surgery is most often performed in teenagers, adults can also undergo correction. The adult chest wall is less flexible, which may make the procedure more demanding and recovery somewhat longer, but many adults do have surgery. A thoracic surgeon can assess whether the potential benefits outweigh the risks in an individual case.

When to see a doctor

If you or your child has a visible dent in the chest, it is reasonable to have it assessed by a doctor, even if there are no symptoms, so that the condition can be documented and monitored over time. You should also arrange an evaluation if the depression appears to be deepening, if posture is changing, or if the appearance is causing emotional distress.

Seek prompt medical attention if any of the following occur:

• Shortness of breath that comes on suddenly or is severe
• Chest pain that is intense, persistent, or spreads to the arm, neck, or jaw
• Fainting or near-fainting, especially during exercise
• A rapid, irregular, or pounding heartbeat that does not settle
• Blue or gray color of the lips or fingertips
• After chest surgery: fever, increasing pain, redness or fluid at the incision sites, or a sudden change in chest shape that could suggest a bar has moved

These signs may indicate a problem with the heart or lungs that needs urgent evaluation, whether or not it is related to pectus excavatum.