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The chest wall protects internal chest organs such as the lungs and heart, as well as some upper abdominal organs such as the liver and spleen. It also provides flexibility during shoulder and arm movements, and contributes to the process of breathing. It is logical, then, that the normal development of the chest wall elements (ribs, spine, collarbones, and the breastbone) is crucial for many physiological functions.

Structural deformities of the chest wall, regardless of being congenital or acquired, are known as chest wall deformities. With the help of advanced radiological, surgical, and clinical evaluation, significant advancement to the knowledge and understanding of these deformities occurred in the last two decades. Pectus excavatum or hollowed chest and pectus carinatum, also known as pigeon chest, are the two most common chest wall deformities.

Pectus Excavatum

This is the most common congenital abnormality of the chest wall, characterized by funnel chest. A variable level of depression of the sternum or lower costal cartilages is seen in this case. These abnormalities occur in the early phases of life and are found three times more often in males than in females.

Various studies tried to examine the cause of pectus excavatum, but no exact cause was found. Association with Marfan syndrome and scoliosis may suggest its relation to connective tissue disorders.

Integrated physical therapy is often the first choice in early life, although many physicians tend to leave mild deformities untreated, considering them to be purely cosmetic problems. Surgery is usually reserved for advanced and severe cases of the disease, although new studies suggest that surgical correction of the deformity can significantly improve the patient's quality of life.

Pectus Carinatum

This is the second most common chest wall deformity. It also occurs more commonly in males. The problem is that the body of the sternum and adjacent costal cartilages protrude, which makes the chest look like a pigeon's breast. Sternal fusion defects (clefts of the breastbone) and deformities of the heart muscle are the other abnormalities associated with pectus carinatum.

The pathogenesis is not very clear, but it is associated with connective tissue disorders, just like pectus excavatum.

Non-operative management is orthotic bracing, which provides front-to-back compression of the chest. Bracing has proven to be very useful, with a success rate of up to 80%. Surgical treatment of pectus carinatum is usually performed in severe cases.

Scoliosis is a very common deformity of the spine that can also cause the chest to look asymmetrical due to a side-to-side curvature of the spine.

A correct posture, exercises, and optimal weight during childhood can prevent a great number of chest wall deformities.

All of the above stated deformities are developmental, which means that they manifest during childhood as the result of a combination of genetic and environmental factors. Besides them, chest wall abnormalities can be acquired due to injuries and tumors, in which case they should be treated properly. Chest x-rays and CT scans of the chest are some of the first procedures that your doctor may order during the diagnostic process.

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