Sunken Chest, medically termed as, Pectus Excavatum is a congenital deformity of the chest in which a person's breastbone (sternum) and several ribs grows in an inward direction giving the appearance that the chest wall is sunken. In a healthy individual, the ribs and sternum go outward at the front of the chest. But in the case of pectus excavatum, the sternum goes inward to form a depression in the chest as if the center of the chest has been scooped out, leaving a deep dent. This gives the chest a concave (caved-in) appearance, hence the condition is also named funnel chest or sunken chest or cobbler’s chest.
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Although, the condition is usually noticed just after birth, the severity of the deformity mainly worsens during the adolescent period, i.e., during the growth spurt of kids. Pectus excavatum occurs in both children and adults but is most commonly noticed in males than the female counterpart. While severe cases of sunken chest can primarily interfere with the normal functioning of the heart and lungs, milder deformity can make any individual self-conscious about the outward appearance.
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The exact cause of sunken chest or pectus excavatum is yet to be discovered but several scientific approaches reveal that it usually occurs due to a developmental issue during pregnancy. Around 35 days into the gestation period, the ribs start to fuse with the breastbone in the foetus. In people with a sunken chest, the breastbone doesn’t fuse as expected, and they develop a sunken chest appearance.
Certain causative factors that increase the risk of Sunken chest include:
Gender: It is more commonly witnessed in males than in females.
Health Condition: Although sunken chest can happen to anyone, the incidence of it is higher in people already suffering from Osteogenesis imperfecta, Noonan syndrome, Marfan syndrome, Ehlers-Danlos syndrome or Turner syndrome.
Some children with pectus excavatum can also have other medical conditions or abnormalities in the bone including Poland syndrome, Scoliosis and Loeys-Dietz syndrome.
The primary symptom of Pectus escavatum is a concave, indented chest. But in chronic cases, the depth of indentation can be severe and worsen in early adolescence and can continue to worsen more into adulthood. In these cases, the breast bone may gradually compress the heart and lungs leading to the following signs and symptoms:
- Chest pain
- Decreased tolerance for exercises
- Rapid heartbeat or heart palpitations
- Recurrent respiratory infections
- Wheezing or coughing
- Heart murmur
- Limitations with certain physical activity
- Shortness of breath
In the case of babies, most often the doctor notices the indentation right after birth but in some cases, it is only noticed and diagnosed till they hit the growth spurt.
Symptoms of sunken chest in a baby include:
- Large, rounded belly
- Shoulders that appear slightly rounded at the edges
- Slightly sloped or inward-turning ribs
Diagnosis And Treatment
On noticing the above-mentioned signs and symptoms in your child or yourself, do consult a doctor at the earliest to avoid complications. The doctor usually does a thorough physical check-up, acknowledges the patient’s past medical history and does a few diagnostics. These include:
Lung Function Test to measure the amount of air the lungs can hold and how quickly one can empty the lungs.
Exercise Test to monitor how well the heart and lungs function while you exercise, usually on a bike or treadmill.
Imaging techniques like CT-scan, Electrocardiogram, Chest X-ray, Echocardiogram etc to detect how well the heart and lungs are working and the dip in the chest bone.
In most chronic and moderate cases, the doctor usually suggests for surgical repair. The two most common surgical procedures include:
Ravitch technique – An older technique where the deformed cartilage is removed, and the ribs are attached to the lower breastbone. The breastbone is then brought to a more normal position with the help of a surgical hardware, such as a metal strut or mesh supports.
Nuss procedure – A minimally invasive procedure where a curved metal bar is threaded under the depressed breastbone, to raise it into a more normal position.
If the condition is mild, the doctor usually suggests physical therapy which mainly helps to improve the posture and also increases the degree to which the chest can expand. But in case a person is conscious about the indented breastbone, and want to repair it, the doctor or surgeon can help by inserting silicone similar to breast implants to fill in the empty space.