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Johns Hopkins Children’s Center

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Pectus Carinatum

What is pectus carinatum?

Pectus carinatum (PC), commonly referred to as “pigeon chest,” is a chest wall malformation in which the sternum and ribs push in an outward direction. It results from overgrowth of the cartilaginous portion of the ribs. Up to half of children with PC will also have some component of pectus excavatum. PC occurs in approximately 1 per 1,500 live births. It is more common in males than females. PC can be present at birth or develop and worsen during teenage growth spurts between ages 11 and 14.

What causes it?

PC can be associated with a variety of genetic disorders and syndromes, including Marfan syndrome, Noonan syndrome, cardiofaciocutaneous syndrome, Poland syndrome, osteogenesis imperfecta, Coffin-Lowry syndrome and Morquio disease. There is a strong familial incidence with up to 25% of cases.

Signs and Symptoms

Patients usually do not experience symptoms, but a small percentage of patients have complained of shortness of breath with exercise with or without chest pain. For many patients, cosmetic appearance is their primary concern.

How is it treated?

PC is treated in two ways. Patients are initially treated with the use of an external bracing device. If bracing fails, pediatric surgeons perform surgery to correct the condition.

External bracing is a cost-effective alternative to surgery, with good success rates. The chest wall is still compliant during the adolescent years, which allows it to be reshaped.

For bracing to work, it requires long-term patient compliance and motivation to achieve success. Bracing consists of patients wearing the device daily for up to 12 or more hours until the chest flattens. The bracing schedule is different between patients, and they will need close follow-up with their pediatric surgeon.

Surgery is the treatment of choice for patients who have a severe malformation and have failed bracing, whose chests are fixed and noncompliant, or who have a combined malformation of pectus carinatum and pectus excavatum.

Surgical repair (modified Ravitch procedure) is done through a horizontal chest incision across the mid chest. In this repair, the abnormal rib costal cartilages are removed, preserving the lining that covers the outside of the cartilage, allowing the sternum to be pushed downward in a more normal position.

Evaluation

If your child has pectus carinatum and would like it corrected, please schedule an appointment with one of our experienced general pediatric surgeons. During your appointment, your surgeon will spend time reviewing the best correction method for your child.

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