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Pediatric Chest Wall Deformities: Top Concerns and Interventions
Chest wall deformities such as pectus carinatum and pectus excavatum usually present in childhood and worsen in adolescence. Refer to a pediatric surgeon to assess severity and determine appropriate treatment.
Pectus Carinatum: Few Symptoms but Cosmetic Concerns
Pectus carinatum (PC) is an uncommon deformity that occurs in about 1 of every 1500 children. It is four times more common in boys than girls, usually presents in childhood, and worsens dramatically during the adolescent growth spurt.
Symptoms are usually rare, but may include pain during exercise. Cosmetic appearance is usually the biggest concern. Up to 30 percent of children with PC also have associated musculoskeletal anomalies, such as scoliosis.
Pectus Excavatum: Pain, Cardiorespiratory Issues More Likely
Pectus excavatum (PE) is more common than PC, occurring in about 1 of every 1000 children. Like PC, it is more common in boys, presents in infancy or childhood, and worsens at puberty.
Children with PE are more likely to have symptoms such as exercise intolerance, chest pain, poor endurance, and shortness of breath. Concerns about physical appearance are common, especially in girls.
Refer to Assess Severity
Both PC and PE are diagnosed through physical examination. Children with either deformity—but especially those with moderate to severe PE who have cardiorespiratory complaints—should be referred to a pediatric surgeon who specializes in chest wall deformities.
During the workup, the team uses chest radiographs or computed tomography (CT) scans to assess the severity of the defect and identify any associated anomalies.
The pectus severity index (PSI), or Haller index, is also used to assess the extent of the defect, as follows:
• Normal chest = PSI 2.5
Treatment Includes Exercise, Compression, Minimally Invasive Surgery
For mild to moderate PC, treatment usually involves compression bracing for six to 20 months. Children who have severe PC, or for whom bracing is ineffective, may require surgical repair.
For mild PE, treatment includes exercises to improve posture and upper-body strength.
For moderate to severe PE, minimally invasive surgical repair is usually indicated. In the procedure, the surgeon places a bar under the sternum that over time reshapes the chest wall. The bar usually remains in place for three years and is them removed.
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For more information about the diagnosis and treatment of pectus carinatum or pectus excavatum, or to contact our comprehensive Pediatric Chest Wall Deformities Clinic, please click here.