Pectus excavatum, also known as 'funnel chest', 'sunken chest' or 'Cobbler's chest', is a congenital chest wall deformity. It is the most common chest abnormality present at birth, appearing in about one in every 300-500 live births. [1] [2] In a person with pectus excavatum, the middle of the chest appears sunken. [9]
Mild pectus excavatum usually does not have any further effects on the body. However, the abnormal appearance it gives the chest can cause body image issues for the person. In severe cases of pectus excavatum, where the sunken area is deep, the lungs and the heart may be affected.
In a person with pectus excavatum, the middle of the chest appears sunken as a result of excessive connective tissue connecting the ribs to the sternum.
Present from birth.
A category of body tissue that connects and supports other body tissues.
The muscular organ in the chest that pumps blood through the body by rhythmic contraction and dilation.
The pair of organs in the chest responsible for breathing.
The flattened bone in the middle part of the chest that connects with the collarbones and some of the ribs. Also known as the breastbone.
Koumbourlis, A.C. (2009) Pectus excavatum: pathophysiology and clinical characteristics. Paediatric Respiratory Reviews 10:3–6.
Dean, C., Etienne, D., Hindson, D., et al. (2012) Pectus excavatum (funnel chest): a historical and current prospective. Surgical and Radiologic Anatomy 34:573–579.
Robert S. Eisinger Journal of Surgical Research March (2019) Pages 93-97.
It is not known what causes pectus excavatum. It is due to abnormal growth of cartilage connecting the breastbone and the ribs. Pectus excavatum is about four times more common in boys than in girls. Of all people with pectus excavatum, 15-40% have a close relative with the condition, [1] [2] suggesting it has some genetic basis.
Pectus excavatum is associated with numerous syndromes, [3] mainly involving bone, muscle and connective tissue, including: [4]
In addition, pectus excavatum is associated with asthma and a higher risk of respiratory infections. [5]
A class of diseases that involves the dysfunction of the heart and/or the blood vessels.
A tough, flexible connective tissue found in various parts of the body including the joints and larynx.
A protein that is the main component of various connective tissues.
Present from birth.
A category of body tissue that connects and supports other body tissues.
The muscular organ in the chest that pumps blood through the body by rhythmic contraction and dilation.
A large, internal organ of the body, located on the upper right-hand side of the abdomen. The liver has hundreds of distinct functions, including producing bile, regulating the body's metabolism and detoxifying the blood.
A genetic disorder that affects the body's connective tissue. This condition can affect many different parts of the body, but commonly affects the heart, blood vessels, bones, joints and eyes.
A type of soft tissue capable of contracting and relaxing to produce force and motion in the body.
The organ system that gives humans the ability to move using their muscular and skeletal systems. It is made up of the bones of the skeleton, muscles, cartilage, tendons, ligaments, joints and connective tissue.
The basic cell of the nervous system. A specialized cell that generates and transmits nerve impulses.
An organ in the abdominal cavity that is involved in filtering out old blood cells and fighting infection.
Relating to respiration, the process of inhaling and exhaling air.
An inherited condition characterized by extremely brittle bones that fracture easily.
Any heart abnormality that is present from birth, such as a narrowing of the vessels or holes in the heart chambers.
Koumbourlis, A.C. (2009) Pectus excavatum: pathophysiology and clinical characteristics. Paediatric Respiratory Reviews 10:3–6.
Dean, C., Etienne, D., Hindson, D., et al. (2012) Pectus excavatum (funnel chest): a historical and current prospective. Surgical and Radiologic Anatomy 34:573–579.
Kotzot, D. and Schwabegger, A.H. (2009) Etiology of chest wall deformities—a genetic review for the treating physician. Journal of Pediatric Surgery 44:2004–2011.
Aloi, I., Braguglia, A. & Inserra, A. (2009). Pectus excavatum. Paediatrics and Child Health 19, Supplement 2: S132–S142.
Fonkalsrud, E.W., Dunn, J.C.Y. and Atkinson, J.B. (2000) Repair of pectus excavatum deformities: 30 years of experience with 375 patients. Annals of Surgery 231:443–448.
Fonkalsrud, E.W., Dunn, J.C.Y. and Atkinson, J.B. (2000) Repair of pectus excavatum deformities: 30 years of experience with 375 patients. Annals of Surgery 231:443–448.
Many people with pectus excavatum have no symptoms and lead a normal life. Symptoms of pectus excavatum can include:
An abnormal or irregular heart rhythm.
The muscular organ in the chest that pumps blood through the body by rhythmic contraction and dilation.
The pair of organs in the chest responsible for breathing.
The flattened bone in the middle part of the chest that connects with the collarbones and some of the ribs. Also known as the breastbone.
Brochhausen, C., Turial, S., Muller, F.K.P., et al. (2012. Pectus excavatum: history, hypotheses and treatment options. Interactive Cardiovascular and Thoracic Surgery 14:801–806.
Pectus excavatum is diagnosed by the appearance of the chest. Further tests can evaluate how each person with pectus excavatum is affected by the condition, if at all. These tests can include:
A scan that uses X-rays to create a 3D image of the body. This can detect abnormalities more effectively than a simple X-ray can.
The muscular organ in the chest that pumps blood through the body by rhythmic contraction and dilation.
The pair of organs in the chest responsible for breathing.
A test used to determine how quickly you take air in, how much air you inhale and how quickly you expel air. It is used to diagnose various lung conditions.
A test that uses electrodes placed on the chest and limbs to record the electrical impulses causing the contractions of the heart.
In many cases, pectus excavatum will remain as it is. In about a third of people, the condition will become more pronounced during puberty [2] .
The period of life, initiated by hormonal signals, in which a person becomes capable of reproduction as the sexual and reproductive organs mature.
Dean, C., Etienne, D., Hindson, D., et al. (2012) Pectus excavatum (funnel chest): a historical and current prospective. Surgical and Radiologic Anatomy 34:573–579.
Pectus excavatum often does not require treatment at all; many people live completely healthy, normal lives. For those who do need (or want) treatment, there are several options:
There are numerous surgical procedures that can repair pectus excavatum. Whether or not to undergo chest 'reconstruction' to repair pectus excavatum depends on the individual case. The timing of surgery is also important; experts currently recommend delaying surgery until after puberty. Nowadays, the Nuss method is preferred over the earlier, more invasive Ravich method, especially for children. [2] [4] [7] It involves inserting a curved metal bar into the chest to remove the central sunken area in the chest.
The 'vacuum bell' is a recent non-surgical treatment method. [4] [8] It involves attaching a large bell-shaped suction cup to the chest and using vacuum to lift the sternum. Repeated treatments show an improvement in pectus excavatum symptoms, but it is not yet clear what the long-term benefits may be.
The period of life, initiated by hormonal signals, in which a person becomes capable of reproduction as the sexual and reproductive organs mature.
The flattened bone in the middle part of the chest that connects with the collarbones and some of the ribs. Also known as the breastbone.
Dean, C., Etienne, D., Hindson, D., et al. (2012) Pectus excavatum (funnel chest): a historical and current prospective. Surgical and Radiologic Anatomy 34:573–579.
Aloi, I., Braguglia, A. & Inserra, A. (2009). Pectus excavatum. Paediatrics and Child Health 19, Supplement 2: S132–S142.
William Rainey Johnson, D.F. (2014). Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum. Journal of cardiothoracic surgery 9:25.
Aloi, I., Braguglia, A. & Inserra, A. (2009). Pectus excavatum. Paediatrics and Child Health 19, Supplement 2: S132–S142.
Haecker, F.-M. (2011) The vacuum bell for conservative treatment of pectus excavatum: the Basle experience. Pediatric Surgery International 27:623–627.