Diagnosis

Pectus excavatum can usually be diagnosed simply by examining the chest. Your doctor may suggest several different types of tests to check for associated problems with the heart and lungs. These tests may include:

  • Chest X-ray. This test can visualize the dip in the breastbone and often shows the heart being displaced into the left side of the chest. X-rays are painless and take only a few minutes to complete.
  • Computerized tomography (CT). A CT scan may be used to help determine the severity of the pectus excavatum and whether the heart or lungs are being compressed. CT scans take many X-rays from a variety of angles to produce cross-sectional images of the body's internal structure. You may be asked to undergo a special CT that looks at the effects of the compression on the heart while breathing in and out.
  • Electrocardiogram. An electrocardiogram can show whether the heart's rhythm is normal or irregular, and if the electrical signals that control the heartbeat are timed properly. This test is painless and involves the placement of more than a dozen electrical leads, which are attached to the body with a sticky adhesive. It is common for a patient with pectus to have an abnormal EKG.
  • Echocardiogram. An echocardiogram is a sonogram of the heart. It can show real-time images of how well the heart and its valves are working. The images are produced by transmitting sound waves via a wand pressed against the chest. An echocardiogram also gives your doctor a look at how the chest wall may be affecting heart function and the flow of blood through the heart.
  • Lung function tests. These types of tests measure the amount of air your lungs can hold and how quickly you can empty your lungs.
  • Exercise test. This test monitors how well your heart and lungs function while you exercise, usually on a bike or treadmill.

Treatment

Pectus excavatum can be surgically repaired, but surgery is usually reserved for people who have moderate to severe signs and symptoms. People who have mild signs and symptoms may be helped by physical therapy. Certain exercises can improve posture and increase the degree to which the chest can expand.

If the depression of your breastbone isn't causing any symptoms but you're unhappy with how it looks, you could talk to a surgeon about having a silicone insert — similar to a breast implant — placed under your skin to fill in that space.

Repair surgery

The two most common surgical procedures to repair pectus excavatum are known by the names of the surgeons who first developed them:

  • Nuss procedure. This minimally invasive procedure uses small incisions placed on each side of the chest. Long-handled tools and a narrow fiber-optic camera are inserted through the incisions. A curved metal bar is threaded under the depressed breastbone, to raise it into a more normal position. In some cases, more than one bar is used. The bars are removed after two or three years.
  • Ravitch technique. This older procedures involves a much larger incision down the center of the chest. The surgeon removes the deformed cartilage attaching the ribs to the lower breastbone and then fixes the breastbone into a more normal position with surgical hardware, such as a metal strut or mesh supports. These supports are removed in six to 12 months.

Most people who undergo surgery to correct pectus excavatum are happy with the change in how their chests look, no matter which procedure is used. Although most surgeries for pectus excavatum are performed around the growth spurt at puberty, many adults also have benefitted from pectus excavatum repair.

Temporarily freezing the nerves to block pain (cryoablation) can help with recovery and decrease postoperative pain for four to six weeks.

Potential future treatments

Doctors are currently studying therapies that use suction or magnets to help raise the depressed breastbone. These devices are best used in younger patients. As people age, the chest becomes more rigid, which limits chest wall movement.

Pectus Excavatum

Pectus excavatum is the most common congenital birth defect. One out of 400 babies is born with a chest wall that doesn't form properly and becomes concave. Kids with pectus routinely have surgery. Adults have either had to live with it or face major more complicated operations. Now, doctors at Mayo Clinic are performing the same surgery for kids on adults and improving the lives of many people.

We're doing a repair of a deformity of the chest wall, called a pectus excavatum.

Dr. Dawn Jaroszewski is a thoracic surgeon, who specializes in pectus repair.

It was once thought that these deformities were all cosmetic and it didn't affect the patient at all. And now, we're finding out that people can have very severe heart and lung problems.

A couple of years ago, I developed a little bit of a wheezey cough.

Michelle Kroeger had a mild case of pectus that got worse over time.

When I'd be running, it'd be harder and harder. I'd get more short of breath. And then I was getting more palpitations in my heart, chest pain.

You can see here this very narrow space between her spine here and her chest.

The concave chest was compressing Michelle's lung, and it shifted her heart to the left. Traditional surgery for adults means major surgery, opening the chest, and remodeling the chest wall. But Dr. Jaroszewski uses a much less invasive technique that was once only used for children.

First, Dr. Jaroszewski makes small incisions on either side of the patient. Then, guided by a small camera, she inserts bars that lift the chest wall into a more normal position.

This is an x-ray, which shows an adult two bars and a nice repair.

The bars are sort of like braces. Michelle will keep them for about two years. When they come out her chest will retain its new shape. Now, she can continue her busy life symptom free.

Michelle says she got relief from symptoms almost immediately after surgery. The only drawback to having the bars in her chest, Michelle says, she sets off the metal detectors in airports, which to her is a small price to pay for a better quality of life. Mayo Clinic is one of only a handful of medical centers in the US performing this operation for adults. For Medical Edge, I'm Vivien Williams.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Coping and support

Most adolescents just want to fit in and look like their peers. This can be exceptionally difficult for youngsters who have pectus excavatum. In some cases, counseling may be needed to help master coping skills. Online support groups and forums also are available, where you can talk with people who are facing the same types of problems.

Preparing for your appointment

If you or your child has pectus excavatum, you might first discuss the condition with your family doctor. He or she may refer you to a doctor who specializes in pediatric or thoracic surgery.

What you can do

You may want to write a list that includes:

  • Detailed descriptions of your signs and symptoms
  • Information about past medical problems
  • Information about medical problems common in your family
  • All the medications and dietary supplements you or your child takes
  • Questions you want to ask the doctor, including what treatments are available

What to expect from your doctor

Your doctor may ask some of the following questions:

  • When did these signs and symptoms begin?
  • Have they worsened recently?
  • Has anyone else in your family had a similar problem?

Pectus excavatum care at Mayo Clinic

April 29, 2020
  1. Kliegman RM, et al. Skeletal diseases influencing pulmonary function. In: Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Jan. 13, 2020.
  2. Mayer OH. Pectus excavatum: Etiology and evaluation. https://www.uptodate.com/contents/search. Accessed Jan 13, 2020.
  3. AskMayoExpert. Pectus excavatum. Mayo Clinic; 2018.
  4. Rodriguez ED, et al. Pediatric chest and trunk defects. In: Plastic Surgery: Volume 3: Craniofacial, Head and Neck Surgery and Pediatric Plastic Surgery. 4th ed. Elsevier; 2018. https://www.clinicalkey.com. Accessed Jan. 13, 2020.
  5. Mayer OH. Pectus excavatum: Treatment. https://www.uptodate.com/contents/search. Accessed Jan 13, 2020.
  6. Morrow ES Jr. Allscripts EPSi. Mayo Clinic. Jan. 14, 2020.
  7. Jaroszewski DE (expert opinion). Mayo Clinic. March 19, 2020.