Pectus Carinatum

What is pectus carinatum?

Pectus carinatum is a condition in which the breastbone (sternum) and the nearby cartilage that connects it to the ribs grow outward, so that the front of the chest protrudes. The name comes from Latin and roughly means “keel-shaped chest,” which is why it is sometimes called pigeon chest or keel chest. It is one of the most common chest wall deformities, second only to pectus excavatum, in which the chest sinks inward instead.

Pectus carinatum usually becomes noticeable during childhood or, more often, during the rapid growth of early adolescence. It is seen more often in boys than in girls. For many people it is mainly a cosmetic concern, but the shape of the chest can affect self-image, and in some cases it is linked with breathing discomfort or other health conditions that need attention.

Doctors describe two main forms. The chondrogladiolar type, which is the most common, involves the middle and lower part of the breastbone pushing forward. The chondromanubrial type, sometimes called Currarino-Silverman deformity, affects the upper part of the breastbone and is less common. The protrusion may be symmetrical or more pronounced on one side.

Pectus carinatum symptoms

The main sign of pectus carinatum is visible: the chest sticks out in the middle or on one side. Many people have no other symptoms at all. When symptoms do occur, they are often mild and may be related to the stiffness of the chest wall or to how the person feels about their appearance.

• Outward bulge of the breastbone, often more obvious when standing or breathing in
• Asymmetry, with one side of the chest more prominent than the other
• Chest wall tenderness or aching, especially where the protrusion presses against clothing or during activity
• Shortness of breath during exercise in some cases, often described as being unable to take a full breath
• Rapid breathing or tiring more easily than peers during sports
• Reduced chest flexibility, sometimes noticed as a stiff feeling when breathing deeply
• Frequent respiratory infections reported by some people, although the link is not firmly established
• Emotional distress, self-consciousness, or avoiding activities such as swimming that involve removing a shirt

How symptoms show up often depends on age and type. In young children, the bulge may be slight and cause no discomfort. During puberty the deformity can become more pronounced quite quickly because the chest wall is growing fast, and this is often when pain, breathlessness, or self-image concerns first appear. In the chondrogladiolar type the lower chest protrudes, while in the chondromanubrial type the upper chest is prominent and the lower breastbone may actually sink slightly inward, giving a mixed appearance.

It is worth knowing that the outward shape of the chest does not compress the heart and lungs in the way an inward-sinking chest can. For that reason, serious heart or lung problems from pectus carinatum alone are uncommon. When breathing symptoms are marked, doctors often look for other explanations, such as asthma, or for an associated condition affecting the connective tissue.

Pectus carinatum causes and risk factors

The exact cause of pectus carinatum is not fully understood. The leading explanation is that the cartilage joining the ribs to the breastbone grows faster or more abundantly than the surrounding bone. This overgrowth pushes the breastbone forward. Why this overgrowth happens in some people and not others is still being studied.

Several factors are known to be associated with the condition:

• Family history. A meaningful share of people with pectus carinatum have a relative with a chest wall deformity, which suggests a genetic contribution, although no single gene has been confirmed as the cause.
• Male sex. Boys are affected more often than girls.
• Rapid growth in adolescence. The deformity often appears or worsens during the growth spurt of puberty.
• Connective tissue disorders. Conditions such as Marfan syndrome (an inherited disorder that affects the body’s connective tissue, including the heart and blood vessels) and Ehlers-Danlos syndrome (a group of inherited disorders affecting collagen) are associated with chest wall deformities.
• Other genetic and skeletal conditions. Pectus carinatum is seen more often in people with certain syndromes, congenital heart disease, and scoliosis (an abnormal sideways curve of the spine).
• Previous chest surgery. In a small number of cases, the deformity develops after open-heart surgery performed in early childhood, because the healing breastbone grows differently.

Pectus carinatum is not caused by poor posture, injury, or anything a parent or child did. It is not contagious, and it is not a sign of cancer. Because it is a developmental condition of the chest wall, there is currently no known way to prevent it.

Pectus carinatum diagnosis

In most cases, pectus carinatum diagnosis begins with a physical examination. A doctor looks at the shape of the chest from the front and the side, checks whether the protrusion is symmetrical, and gently presses on the chest wall to judge how flexible it is. Flexibility matters because it strongly influences which treatments are likely to work. The doctor will also ask about symptoms, family history, and when the change in shape was first noticed.

Because the diagnosis is usually obvious on examination, further tests are not always necessary. However, your doctor may recommend some of the following to measure the deformity, rule out other conditions, or plan treatment:

• Chest X-ray. A front and side X-ray shows the position of the breastbone and can reveal scoliosis or other bone changes.
• CT scan (computed tomography). This detailed cross-sectional imaging is sometimes used before surgery to measure the chest shape precisely, often using an index that compares chest width and depth.
• Pulmonary function tests. Simple breathing tests that measure how much air the lungs can hold and how quickly air moves in and out. They are used when a person reports breathlessness.
• Echocardiogram or electrocardiogram. These heart tests are ordered if there are signs of a connective tissue disorder or a heart murmur, since these conditions can occur together.
• Genetic evaluation. If features of Marfan syndrome or a similar disorder are present, referral to a genetics specialist may be suggested.
• Pressure measurement. Some clinics measure the pressure needed to flatten the protrusion, which helps predict whether a brace is likely to be effective.

Chest wall deformities are commonly assessed by pediatric surgeons or thoracic surgeons. At Acibadem, this evaluation is managed by the Thoracic Surgery Department, working with other specialists when related conditions are suspected.

Pectus carinatum treatment options

Treatment depends on the person’s age, how flexible the chest wall is, how severe the protrusion is, and how much it bothers them. Because the condition rarely threatens health on its own, the decision to treat is often shared between the patient, the family, and the care team.

Observation

For young children with a mild bulge and no symptoms, doctors often recommend simply monitoring the chest during regular checkups. Some mild cases do not progress significantly. Because puberty is when the deformity may worsen, periodic reassessment during those years is typical.

Orthotic bracing

External bracing is the most common first-line pectus carinatum treatment for children and adolescents whose chest wall is still flexible. The brace is a lightweight device worn around the chest that applies gentle, steady pressure to the protruding area. Over months, this pressure can guide the growing cartilage into a flatter position, in a way similar to how braces reshape teeth.

Braces are usually custom fitted and adjusted at follow-up visits. Wearing time varies; some protocols call for many hours a day at first, followed by a shorter maintenance period once the chest has flattened. Results tend to be better when the brace is started before the growth spurt ends and when it is worn consistently. Side effects can include skin irritation or redness at the pressure points, which usually improves with adjustments. Bracing is less effective once the skeleton has matured, because the cartilage becomes stiff.

Exercise and physical therapy

Exercises alone do not correct the shape of the breastbone, but they are often recommended alongside bracing. Strengthening the chest and back muscles and improving posture can make the protrusion less noticeable and may help with the stiff feeling some people describe. A physical therapist can provide a program that also addresses shoulder position and breathing technique.

Surgery

Surgery is generally reserved for people whose chest wall is too rigid for bracing, whose deformity is severe, whose bracing was not successful, or who have significant symptoms. The most established operation is a modified Ravitch procedure. In this open surgery, the surgeon removes the overgrown cartilage segments, repositions the breastbone in a flatter position, and may place a temporary support bar or plate that is removed later. Recovery involves a hospital stay, several weeks of limited activity, and avoidance of contact sports for a period.

Minimally invasive approaches have also been developed for selected patients. One technique places a metal bar under the skin and over the breastbone, held by attachments to the ribs, to press the chest inward gradually; the bar is removed after a couple of years. Not every patient is a candidate for these approaches, and your surgeon may explain which option, if any, fits your anatomy.

As with any operation, risks include infection, bleeding, pain, fluid or air around the lung, recurrence of the deformity, and reaction to implanted hardware. These risks are weighed against the expected benefit for each person.

Recovery and follow-up

After bracing or surgery, follow-up visits track chest shape, comfort, and any complications. Return to full sports activity after surgery is usually gradual and guided by the surgical team. Ongoing posture and strengthening exercises are often encouraged regardless of the treatment chosen.

Living with pectus carinatum and outlook

For most people, pectus carinatum does not shorten life or cause serious medical harm. Many adults with an untreated mild deformity live entirely normally and simply consider it part of how their body looks. Others find that the change in appearance, especially during adolescence, affects confidence and social life, and that concern is as valid a reason to seek care as any physical symptom.

When treatment is chosen, outcomes are often good, particularly with bracing started while the chest is still flexible, but individual results vary and cannot be guaranteed. Some improvement may be lost if a brace is stopped early, and a small proportion of people experience partial recurrence after surgery. Realistic expectations, set together with the care team, tend to lead to greater satisfaction.

Practical strategies that many people find helpful include working with a physical therapist on posture, staying physically active, and, for young people, having open conversations with parents and teachers about self-image. If the condition is part of a connective tissue disorder, long-term follow-up of the heart and other systems is more important than the chest shape itself, and your doctor may arrange regular checks.

Frequently asked questions

Is pectus carinatum dangerous?

In most cases, no. Because the breastbone pushes outward rather than inward, it does not compress the heart or lungs. Health problems are uncommon and, when they occur, are usually mild or related to an associated condition rather than the chest shape itself. Your doctor may still check heart and lung function if you have symptoms.

What are the first pectus carinatum symptoms parents notice?

Parents most often notice that the child’s chest looks pointed or that one side sticks out more than the other, frequently around the start of puberty. Some children mention chest tenderness or feeling they cannot take a deep breath, but many have no symptoms beyond the visible shape.

What causes pectus carinatum to appear in teenagers?

The likely cause is overgrowth of the cartilage between the ribs and breastbone during the rapid growth of adolescence. A tendency toward this growth pattern often runs in families. It is not caused by posture, sports, or injury.

How is pectus carinatum diagnosis confirmed?

A doctor can usually confirm the condition by examining the chest. Imaging such as a chest X-ray or CT scan may be used to measure severity or plan treatment, and breathing or heart tests are added if there are symptoms or signs of a related disorder.

Does pectus carinatum treatment always require surgery?

No. For children and teenagers with a flexible chest wall, a custom brace worn over many months is the usual first treatment and is often effective. Surgery is generally considered when the chest is too rigid for bracing, the deformity is severe, or bracing has not worked.

Can adults with pectus carinatum still be treated?

Bracing is much less effective once bone growth has finished, because the cartilage becomes stiff. Adults who wish to correct the deformity are usually evaluated for surgical options, and the decision depends on severity, symptoms, and personal preference.

Can pectus carinatum come back after treatment?

Partial recurrence is possible, particularly if a brace is stopped before growth is complete or if surgery is performed while the chest is still growing. Follow-up with the care team helps identify and manage any return of the protrusion.

When to see a doctor

It is reasonable to have any noticeable change in chest shape evaluated, especially in a growing child, since early assessment gives the widest range of treatment options. Also seek an evaluation if the shape is causing pain, breathlessness, or emotional distress, or if there is a family history of connective tissue disorders.

Seek urgent medical attention if any of the following occur, as they are not typical of pectus carinatum alone and may indicate another problem:

• Sudden or severe chest pain, especially pain that spreads to the arm, jaw, or back
• Difficulty breathing at rest or breathlessness that is rapidly worsening
• Fainting, near-fainting, or a racing or irregular heartbeat, particularly during exercise
• Blue or gray lips or fingertips
• Fever, redness, swelling, or drainage at a surgical site after chest wall surgery
• Sudden change in chest shape following an injury or after surgery
• Coughing up blood

These signs warrant prompt evaluation regardless of whether a chest wall deformity is present.