Diagnosis

Pectus excavatum can usually be diagnosed simply by examining the chest. But 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.
  • 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.
  • 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.
  • 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.

Types of surgery

If you have moderate to severe pectus excavatum, your doctor may suggest surgery. The two most common types of surgeries used to correct pectus excavatum differ by the size of the incisions used and whether or not cartilage is removed:

  • Smaller incisions. For a minimally invasive procedure, small incisions are placed on each side of the chest, under each arm. 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.
  • Larger incision. A center-of-the-chest incision allows the surgeon to view the breastbone directly. The deformed cartilage attaching the ribs to the lower breastbone is removed and the breastbone is fixed 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. Best results are achieved when the surgery is performed around the growth spurt at puberty, but adults also have benefitted from pectus excavatum repair.

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 matter 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 the 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?