Pectus excavatum: Treatment for hollow chest is more than cosmetic

In Latin, pectus excavatum translates to "chest hollow." This term describes a condition in which the chest is sunken in the center or to one side. Depending on the severity, pectus excavatum can be a noticeable disfigurement, but the effects are more than cosmetic. The condition can have a significant impact on daily life and physical activities.

Who is most affected by pectus excavatum?

The congenital chest wall anomaly is seen most in children and tends to affect boys more than girls. It can develop when children go through a growth spurt, around 8 to 10.

With pectus excavatum, the cartilages grow abnormally, which pushes the bony sternum in so it only changes when a child grows. Parents may notice this depression after the child experiences a significant growth spurt as the chest becomes more sunken.

How is pectus excavatum evaluated?

Evaluation is important to determine whether the appearance of the chest results from a weakness of the chest wall or a deformity, such as pectus excavatum. As a young child grows and becomes stronger, weakness in the chest may disappear and not develop into pectus excavatum.

The severity of the condition can range from mild to severe. A measurement called the Haller index is used to grade the severity.

Typically, a chest X-ray measures the width of the chest inside the rib cage and the depth of the chest from the back of the sternum to the vertebrae of the spine. The width calculation divided by the depth shows how much space is in the chest for the heart and lungs.

On occasion, additional imaging, such as a CT scan is required to measure for Haller index accurately.

For a person who does not have pectus excavatum, the Haller index number is around 2.5 cm. A moderate condition level would have an index of 3.25 cm or higher.

The higher the index number, the more severe the condition. The heart and lungs may not work properly with less space in the chest. This can lead to shortness of breath with exercise or other physical activity.

What is the treatment for pectus excavatum?

For mild cases, there are some nonoperative options to improve pectus excavatum. When the condition is mild, many people can live with it normally.

Surgery becomes an important treatment option for a Haller Index greater than 3.25 cm.

During a Nuss procedure, a curved metal bar made of nickel or titanium is inserted through small incisions on each side of the chest. The bar is flipped over to push the breastbone up using the bar's arch. More than one bar may be used in some cases. The bar is removed after two to three years.

Surgery stops the sternum from pushing on the heart and lungs, allowing for better breathing. Children may be able to perform better athletically or be able to keep up with their peers in common activities, like walking, climbing stairs or riding a bike.

Pectus excavatum myths

Myth: Treatment for pectus excavatum is cosmetic.
Fact: While children can be self-conscious about the shape of the chest, most patients are healthier after surgery to correct pectus excavatum. After the sternum is put in the correct position using a metal bar, children may have improved breathing and increased endurance with exercise.

Myth: Recovery from the surgery is painful.
Fact: Prior to surgical advancements, recovery used to include being in bed for five days after the surgery in the hospital. Now, most patients leave the next day after surgery. This is due to cryotherapy, which treats the nerves on each side of the body and decreases the use of narcotic pain medicine after leaving the hospital.

Myth: After surgery, a magnet will stick to the bar in a child's chest.
Fact: A normal magnet will not stick to the chest. Children can still have an MRI scan with the bar in place by disclosing the medical equipment before the MRI.

Myth: A child can't travel by airplane after having pectus excavatum surgery.
Fact: The bar inserted during surgery will not limit travel in the U.S. A letter of disclosure for the medical device can be used when going through a metal detector.

Learn more about pectus excavatum:

• Indiana boy standing tall and hitting the beach after surgery to correct pectus excavatum
• Pectus excavatum treatment at Mayo Clinic Children's Center (video)
• Sharing Mayo Clinic: Scarlett is running and smiling after surgery to correct pectus excavatum
• Ask the Mayo Mom: Surgical options to repair pectus excavatum
• Mayo Clinic Q and A: Understanding and treating pectus excavatum
• Why choose Mayo Clinic for pediatric surgery (video)

D. Dean Potter Jr., M.D. is a pediatric surgeon, and consults with patients in La Crosse, Wisconsin.