Two main types of deformation
Funnel-shaped deformity is the most common: the central part of the sternum and adjacent costal cartilages sink, forming a depression of varying depth, sometimes asymmetrical. The keeled deformity is less common: the sternum protrudes forward, and the ribs on the sides seem to be depressed, which is why the chest resembles the keel of a boat. There are both mixed and one-sided options. Both conditions are not a disease of muscles or posture, but a feature of the growth of costal cartilages, so “pumping up the pectoral muscles and fixing everything” will not work, although training improves posture and appearance.
- Funnel chest - a depression in the center of the chest
- Keeled chest - protrusion of the sternum forward
- Mixed and asymmetrical shapes
- The deformity is often noticeable from the first years of life
- Sharp increase at 11–15 years of age against the backdrop of a growth spurt
Causes and associated conditions
It is based on excessive growth of the cartilaginous part of the ribs, which does not fit between the sternum and the spine and bends the sternum inward or outward. The exact mechanism is not fully understood, but the role of heredity is supported by familial cases. Deformation is more common in connective tissue diseases, so the doctor must examine the joints, skin, assess the height and proportions of the body, check vision and the condition of the aorta. Rickets and previous surgeries on the chest can also change its shape.
- Hereditary predisposition, cases in the family
- Connective tissue syndromes, including Marfan syndrome
- Males get sick several times more often
- Previous chest surgeries
- Severe rickets in early childhood
- Scoliosis, often accompanying deformity
How deformation affects the heart and lungs
With a small funnel, the internal organs do not suffer, and there are no complaints. With deep deformation, the sternum moves closer to the spine, the heart moves to the left and rotates, and the volume of the chest cavity decreases. Then shortness of breath appears when running, fatigue, palpitations, and sometimes chest pain. Some teenagers do not notice the restrictions, because from childhood they adapt their lifestyle to them and simply avoid stress. Therefore, assessment of pulmonary and cardiac function is important even in the absence of active complaints.
- Displacement and rotation of the heart with a deep funnel
- Decreased exercise tolerance
- Shortness of breath and palpitations when running
- Mitral valve prolapse is more common
- Frequent respiratory infections with severe deformity
Diagnostics
The doctor examines and measures the chest, photographs it in standard positions for dynamic comparison, and evaluates posture and spine. A chest x-ray shows the displacement of the heart and allows one to exclude lung pathology. Computed tomography provides accurate measurements and calculation of the Haller index - the ratio of the width of the chest to the distance between the sternum and the spine, which is used when deciding on surgery. EchoCG evaluates the position of the heart and valves, spirometry evaluates the function of external respiration.
- Inspection, measurement and photographic documentation of deformation
- Chest X-ray in two projections
- CT scan of the chest with calculation of the Haller index
- Echocardiography to evaluate the heart and valves
- Spirometry to assess lung function
- Consultation with a geneticist for suspected connective tissue syndrome
Treatment: from corset to surgery
For minor deformities without dysfunction, observation, physical therapy, breathing exercises and swimming are sufficient - they improve posture and mobility of the chest. For keeled breasts in a growing teenager, a dynamic compression corset works well: gentle, constant pressure gradually flattens the sternum. For pectus excavatum, a vacuum bell is used, which is most effective in children with an elastic chest. Surgery is considered in cases of severe deformity, proven effects on the heart and lungs, or severe psychological discomfort: more often, a minimally invasive correction is performed with the installation of a plate, which is removed after a few years.
- Observation and physical therapy for mild cases
- Breathing exercises and swimming
- Dynamic compression corset for keeled breasts
- Vacuum bell for pectus excavatum
- Minimally invasive correction with plate installation
- Open surgery for complex and recurrent forms