Chest Wall Malformations (Pediatric)

What are chest wall malformations?

Chest wall malformations are deformities that range from mild to severe and are often present at birth. The most common types are: 

Pectus carinatum: bulging of the chest caused by malformed ribs protruding outward.

Pectus excavatum: sunken chest caused by abnormal curvature of the ribs toward the spine. 

What are the symptoms of chest wall malformations?

  • Physical appearance of the chest
  • Fatigue 
  • Shortness of breath on exertion
  • Chest pain
  • Fast heartbeat or chest murmur 

How are chest wall malformations diagnosed?

  • Visual examination of the chest
  • Ausculation: analysis of sounds of heart and chest to detect the condition's effect on heart and lung function
  • Electrocardiogram (ECG)
  • Echocardiogram: noninvasive test that uses sound waves to take a picture of the heart 
  • Pulmonary function testing: measures the amount of air breathed over a period of time
  • Chest X-ray
  • MRI scan (radiation-free)

What is the treatment for chest wall malformations?

Pectus cavernatum is often treated non-surgically with a bracing procedure that applies pressure to the chest, gradually molding it into the correct position over 12-18 months. 

Pectus excavatum is usually treated by the Nuss procedure, a minimally invasive technique done using video-assisted, camera-aided thoracoscopic surgery. A convex bar steel or titanium pectus bar is specially shaped to fit the patient's body, inserted through the passage, and turned to push the sternum outward. The bars are left in place for 2-3 years, then removed.