Pediatric Chest Wall Deformities

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UT Southwestern Medical Center’s pediatric surgeons are experts at diagnosing and treating children, adolescents, and young adults with chest wall deformities – common conditions that can negatively affect a patient's self-image.

Our highly trained team offers surgical and nonsurgical treatments to help young patients look and feel their best.

Compassionate Care for Children with Chest Wall Deformities

Chest wall deformities are caused by physical abnormalities of the chest. These conditions, which exist at birth (congenital), generally fall into two types:

Pectus excavatum (sunken chest): breastbone pushes inward
Pectus carinatum (pigeon chest): breastbone protrudes outward

UT Southwestern Pediatric Group surgeons provide expert care for pediatric patients with chest wall deformities. Our Center for Chest Wall Anomalies and Pectus is one of the few in the country offering the Dynamic Compression Bracing System, an advanced treatment for patients with pectus carinatum.

Our faculty performs leading-edge clinical studies focused on improving the diagnosis and treatment of patients who have chest wall deformities.

Causes of Pediatric Chest Wall Deformities

The exact cause of chest wall deformities is unknown, but these conditions of irregular growth of the cartilage that connects the ribs seem to run in families, although they are not hereditary.

Pectus (and other skeletal malformations) can occur in patients with Marfan syndrome and other connective tissue disorders.

Symptoms of Pediatric Chest Wall Deformities

Pectus excavatum can be associated with minor to severe signs and symptoms, such as:

An indentation of the chest
Exercise-induced shortness of breath
Decreased tolerance of exercise
Chest or joint pain

Often, the chest indentation or protrusion may not be noticed until it becomes more obvious during the adolescent growth spurt.

Pectus carinatum can be associated with pain at the chest wall joints – its most common symptom. It, too, is usually noticed during the child’s adolescent growth spurt.

Diagnosing Pediatric Chest Wall Deformities

To diagnose chest wall deformities, our surgeons begin with a thorough history and physical examination.

Additional tests might be needed to determine the extent of the condition, including:

Computed tomography (CT) scan or X-rays to measure the Haller index, which determines the severity of the chest wall depression (for pectus excavatum) and is often used in preparation for surgical procedures
Dermal test to evaluate sensitivity to the metal used in the surgical procedure
Electrocardiogram (EKG) and echocardiography to help determine heart function
Pulmonary (lung) function test to help determine severity of pulmonary dysfunction

Pediatric Chest Wall Deformities Treatment

Our team of experts provides surgical and nonsurgical treatments, depending on the severity and type of condition. Some chest wall deformities do not require treatment.

Pectus excavatum treatment

Treatment options for pectus excavatum include:

Exercise: For mild conditions, targeted exercises can improve posture and upper body strength.
The Nuss procedure: The surgeon inserts a curved metal bar beneath the patient’s ribs and breastbone to lift the anterior chest wall; the bar is removed after approximately 2-3 years.
The Ravitch procedure: The surgeon removes the problematic (curved) cartilages and repositions the breastbone. This procedure is rarely required.

Pectus carinatum treatment

Most cases of pectus carinatum can be treated with bracing, which gently pushes back the breastbone into a normal position. Types of bracing include:

Circular Brace, an off-the-shelf, non-customized option
Dynamic Compression Brace, which is customized based on the patient’s chest measurements

Our Center for Chest Wall Anomalies and Pectus is one of the few facilities in the country with a team that has been specially trained to complete the customized chest measurements for the Dynamic Compression Brace, supply the brace, and provide follow-up for pectus carinatum.

Rarely, bracing is unsuccessful in correcting pectus carinatum; surgical options are then recommended. In those cases, we perform the Ravitch procedure, in which the surgeon removes the problem cartilage and repositions the breastbone.