Pectus Carinatum

Overview

What is pectus carinatum?

Pectus carinatum is a condition in which the sternum (breastbone) protrudes, or sticks out, more than usual. It is the opposite of pectus excavatum, in which the breastbone is depressed inward and gives the chest a sunken appearance.

Who is affected by pectus carinatum?

Pectus carinatum is more common in boys. Although babies are born with the condition, it is often not noticed until the child reaches puberty (teen years).

Symptoms and Causes

What causes pectus carinatum?

Although the exact causes of pectus carinatum are not known, it is believed to be a disorder of the cartilage that joins the ribs to the breastbone.

Pectus carinatum can sometimes be heredity (runs in the family). In some patients, pectus carinatum may be associated with Marfan syndrome, a connective tissue disorder that has the following symptoms:

  • Long limbs and fingers
  • Chest abnormalities
  • Curvature of the spine
  • Certain facial features
  • Specific changes in the heart valves and aorta; and,
  • Displacement (movement) of the lenses of the eyes.

What are the symptoms of pectus carinatum?

Symptoms may be more severe for some patients than for others, and may include any of the following:

  • Fatigue (feeling tired and weak)
  • Shortness of breath
  • Chest pain
  • Tachycardia (fast heart rate)

Diagnosis and Tests

How is pectus carinatum diagnosed?

The doctor will take the patient’s medical history and perform a physical examination. The main test for diagnosing pectus carinatum is a chest X-ray from the front and side. In certain cases, the patient may have a computed tomography (CT) or magnetic resonance imaging (MRI) scan.

In addition, patients who have heart palpitations may have an electrocardiogram (EKG) or an echocardiogram (a picture of the heart). The doctor may also check to see if the patient has scoliosis (curvature of the spine).

Management and Treatment

How is pectus carinatum treated?

If pectus carinatum is causing symptoms, there are two treatment options: bracing and surgery.

  • Bracing for pectus carinatum works similar to the way braces work on teeth. The brace is worn around the chest and provides pressure from both the front and back to move the breastbone back to its usual position. The child wears the brace for up to 24 hours a day, for a period of months to years. The brace can be removed for showering, sports and other activities.
  • Surgery for pectus carinatum involves a technique called the Ravitch procedure. This procedure is completed with an incision (cut) in the mid-chest area to remove anterior (in the front) cartilage. Stainless-steel struts are placed across the anterior chest to support the breastbone, allowing the breastbone to be elevated. The struts are not visible from the outside and are later removed during a surgical procedure.

What are the risks of correction of pectus carinatum?

Bracing treatment for pectus carinatum is very safe. A small number of patients may have irritation or breakdown of the skin where the brace makes contact. Patients are taught to stop using the brace at the first sign of any irritation. They are then asked to return to the office so that the brace can be adjusted.

The surgical repair of pectus carinatum, like other extensive surgeries, carries certain risks. While the Ravitch procedure is also safe and effective, complications can occur, including:

  • Pneumothorax (a buildup of air or gas in the pleural space around the lung)
  • Bleeding
  • Pleural effusion (fluid around the lung)
  • Pericarditis (inflammation around the heart)
  • Infection
  • Bar displacement (movement)
  • Recurrence (return) of the pectus carinatum condition

Outlook / Prognosis

What is the prognosis (outlook) for patients who have pectus carinatum?

The outlook for patients who have pectus carinatum is generally very good. Patients who wear a brace or have the surgery are usually very satisfied with the results and with their appearance.

Resources

Cleveland Clinic Information

Last reviewed by a Cleveland Clinic medical professional on 01/21/2019.

References

  • American Pediatric Surgical Association. Pectus Carinatum. Accessed 1/22/2019.
  • National Center for Advancing Translational Sciences/Genetic and Rare Diseases Information Center. Pectus carinatum. Accessed 1/22/2019.
  • Desmarais TJ, Keller MS. Pectus carinatum. Curr Opin Pediatr 2013 Jun;25(3):375-81. doi: 10.1097/MOP.0b013e3283604088.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy