Chest Wall Disorders in Children
The term pectus can refer to a wide variety of chest wall defects that can occur in children. Pectus disorders or malformations can be present at birth or may become more noticeable as a child grows into adolescence. Sometimes parents notice a minor chest wall defect in a child when they're younger and a after a growth spurt they become more apparent.
Pectus carinatum is sometimes referred to as “pigeon chest" and refers to a protrusion of the chest wall. Generally, pectus carinatum does not cause symptoms for children. Sometimes if the protrusion is asymmetrical the child may experience chest pain or other symptoms.
Pectus excavatum is a disorder that presents as a sunken chest. This chest wall abnormality is relatively common. It occurs much more frequently in boys compared to girls, but it can be seen in both sexes. Symptoms include shortness of breath or chest pain with exertion. A common scenario includes children who previously were very active in physical activities, and then they start dropping off various things because they just can't keep up as well as they used to. It's very common for children with pectus excavatum to get more short-of-breath compared to their peers.
Treatment of Chest Wall Disorders
Pectus Carinatum: Pectus carinatum can be treated surgically or with external bracing. Recently we've found that we can treat almost all carinatum patients with external bracing. The timing of the bracing is important because you want to get started when the chest wall is still pliable and is amenable to bracing. Typically, children wear the brace for 12 to 18 months. The only surgical option to treat pectus carinatum is the Ravitch procedure. This is an open procedure with resection of the chest wall.
Pectus Excavatum: Not every child with pectus excavatum needs to have it repaired. Patients who consider repair are those who have symptoms with exertion. The two main ways to fix it are the Ravitch procedure and the Ness procedure. The Ravitch procedure is an incision across the chest and resection of some of the cartilage of the ribs and breaking of the breastbone. This procedure has been pretty much replaced for most people with what's called the Ness procedure. The Ness procedure involves putting a camera inside of the chest and then tunneling across the chest to measure from the right side to the left. Then surgical steel bars are bent to the shape the chest should be and placed it across the chest, much like braces on teeth. The bar is left in place for the body to remodel itself and removed two to three years later. Usually by three months they're back to full, normal activity and not taking medications.