The pectus excavatum is also known as a “funnel chest” or “hollow chest”. It is a deformation of the thorax characterized by a more or less significant depression of the sternum. Pectus excavatum is more common in men than in women, and usually occurs during adolescence. Several treatment options can be considered.

Definition of pectus excavatum

The pectus excavatum represents on average 70% of the cases of deformity of the thorax. This deformation is characterized by a greater or lesser depression of the anterior wall of the chest. The lower part of the sternum, a flat bone located in front of the thorax, sinks inwards. In common parlance, we speak of “funnel chest” or “hollow chest”. This deformation constitutes an aesthetic discomfort but also presents a risk of cardio-respiratory disorders.

Causes du pectus excavatum

The origin of this deformation is not yet fully understood. The most recent studies suggest that it is the result of a complex mechanism. However, the most commonly accepted cause is that of a growth defect in the cartilage and bone structures of the ribs.

A genetic predisposition could explain some cases. A family history has indeed been found in about 25% of cases of pectus excavatum.

DIAGNOSTIC du pectus excavatum

It is usually based on a physical examination and a medical imaging examination. An MRI (magnetic resonance imaging) or CT scan is usually done to measure Haller’s index. This is an index to assess the severity of pectus excavatum. Its average value is around 2,5. The higher the index, the more severe the pectus excavatum is considered. The Haller index allows healthcare professionals to guide the choice of treatment.

To assess the risk of complications, practitioners may also request additional examinations. For example, an EKG can be done to assess the electrical activity of the heart.

People affected by pectus excavatum

Pectus excavatum can appear from birth or during infancy. Nevertheless, it is most often observed during the growth phase between 12 years and 15 years. The deformation increases as the bone grows.

The worldwide incidence of pectus excavatum is between 6 and 12 cases per 1000. This deformity concerns approximately one birth in 400 and preferentially affects the male sex with a ratio of 5 boys affected for 1 girl.

Aesthetic discomfort

Those affected most often complain of the aesthetic discomfort caused by the pectus excavatum. This can have a psychological impact.

Cardio-respiratory disorders

Deformity of the chest can interfere with the functioning of the heart muscle and respiratory system. Cardio-respiratory disorders can be seen with the following signs:

• dyspnea, or difficulty breathing;
• loss of stamina;
• tiredness ;
• dizziness ;
• chest pain;
• palpitations;
• tachycardia or arrhythmia;
• respiratory infections.

The choice of treatment depends on the severity and discomfort caused by pectus excavatum.

Surgery may be done to treat pectus excavatum. It can use two methods:

• the open operation, or sterno-chondroplasty, which consists of an incision of about 20 cm to reduce the length of the malformed cartilages then the placement of a bar on the anterior face of the thorax;
• the operation according to Nuss which consists of two incisions of 3 cm under the armpits to introduce a convex bar whose rounding allows the sternum to be raised.

The operation according to Nuss is less cumbersome than the open operation but is only carried out under certain conditions. It is considered when the depression of the sternum is moderate and symmetrical, and when the elasticity of the chest wall allows it.

As an alternative or in addition to surgical correction, a vacuum bell treatment can be offered. This is a silicone suction bell that gradually reduces chest deformity.

To date, no preventive measures have been put forward. Research continues to better understand the cause (s) of pectus excavatum.