Pediatric Pectus Excavatum

Pediatric pectus excavatum, also known as sunken or funnel chest, is a congenital condition where a child’s breastbone (sternum) grows inward and the chest appears dented or hollow.

Formed during pregnancy, it’s the most common chest wall deformity in children and usually becomes more noticeable during periods of rapid growth, such as puberty.

Severe cases of pectus excavatum may compress the lungs and heart.

This condition is the opposite of pectus carinatum, where the sternum abnormally protrudes.

Schedule an appointment

Pediatric Surgery

What causes it?

The exact cause is unknown but may occur with or without a family history. Pectus excavatum is more common in boys than in girls. It may also occur in individuals diagnosed with conditions such as Marfan syndrome, Ehlers-Danlos syndrome, osteogenesis imperfecta, Noonan syndrome, or Turner syndrome.

What are the symptoms?

Pectus excavatum can have physical and psychological signs, which can impact normal social development. The only physical sign for many people is a slight indentation in their chest.

Physical symptoms include:

  • Shortness of breath with exercise
  • Less stamina compared to peers
  • Fatigue or dizziness
  • Chest pain
  • Irregular heartbeat
  • Heart palpitations or rapid heartbeat
  • Wheezing or coughing

Psychological symptoms include:

  • Self-esteem concerns
  • Body-image concerns
  • Embarrassment
  • Depression

How is it diagnosed?

Pectus excavatum is usually diagnosed through a physical examination. A doctor will observe the chest’s shape and symmetry and may ask about physical symptoms, such as breathing difficulties or chest pain. Tests for pectus excavatum may include pulmonary function tests, magnetic resonance imaging (MRI) or computed tomography (CT) of the chest, echocardiogram, cardiopulmonary exercise testing, and/or an electrocardiogram (EKG).

How is it treated?

Depending on the severity of the pectus excavatum, doctors may recommend physical therapy for minor cases and surgery for moderate to severe cases that may impact a child’s growth and development.

Surgery is generally performed when patients are between 10 and 14 years of age to correct deformity, improve posture, and restore lung and heart function. Although most pectus surgery is performed during the teenage years, our program sees and treats patients of all ages, from children to adults.

Minimally invasive surgeries with small incisions are performed using a “Nuss procedure,” which uses one or more metal bars to raise a child’s concave breastbone. On occasion, traditional surgeries may be required using a “Ravitch procedure,” which involves removing abnormal cartilage to allow the sternum to move forward to the normal position. 

In our practice, pectus excavatum repair is performed using nerve blocks with analgesic medications and a nerve-freezing technique known as cryoanalgesia. This combination provides pain relief in the short term right after surgery and long term for months to help with recovery. Our surgeons have led the way in improving pain control for this operation. Our approach to pain management results in minimal pain and almost no utilization of narcotic medications after surgery. Speak to your doctor for more information.

After surgery, most children recover well and can return to normal activities within weeks or months. Most patients are in the hospital two to three days. It may take two to three weeks to develop the stamina to return to normal daily activity, like school. Within three to four months, children can go back to more rigorous physical tasks, such as sports and heavy lifting. Every patient is different and your pediatric surgeon will help guide your child’s recovery. Regular follow-up visits are needed to ensure that the chest is healing correctly and that any complications are addressed promptly, such as infection and bar movement. Generally, the Nuss bars are removed after about three years.

Visit our pediatric surgery page to learn more about our services and providers.