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Deformities or abnormal development of the chest wall are congenital abnormalities that can vary from mild to severe. They may be noticeable at birth or may become apparent later in childhood, progressing rapidly during puberty. There is a variety of chest wall anomalies, but the most common are pectus excavatum (or sunken/funnel chest) and pectus carinatum (or pigeon chest).

A person who has a protruding breast plate or sternum is said to have pectus carinatum, which occurs due to an abnormal growth of the cartilages connecting the ribs to the sternum. Instead of growing flat along your chest wall, the cartilages grow outward and push your sternum forward, resulting in a sharply pointed chest, like a pigeon breast. There can be chest asymmetry, with one side being more prominent than the other. This condition occurs in one out of 1,500 children, mostly boys, and become apparent late in childhood. Some children do not experience symptoms, but others may report difficulty in breathing, chest pain and decreased stamina with exercise.

Low self-esteem may also be associated with poor body image.

Pectus carinatum tends to run in families and is more frequent in whites, but uncommon in blacks and Asians. It may be associated with frequent respiratory infections, asthma, and other disorders such as scoliosis, kyphosis, musculoskeletal defects, and heart disease. The cause is not known.

Treatment Of Pectus Carinatum

Mild cases do not need any treatment at all. Children with pectus carinatum usually lead completely normal lives, even if they end up getting braces or surgery.

If the child is not symptomatic, no treatment is needed. However, standard treatment requires bracing of the chest wall with a custom-fitted circumferential external brace to put a sustained force on the prominent portion of the sternum and cartilages. This will result in flattening or regression of the chest wall. An orthotist who is skilled in treating children with chest wall deformities fits the brace which the child must wear throughout the day and night for many months. Casting followed by bracing or bracing alone may work in mild-to-moderate cases if the chest wall is still flexible. This eliminates the risks of surgery and anesthesia.

Success rates have been reported at 65-80 percent, with encouraging long-term outcomes.

Patients with pectus carinatum who have significantly poor body image or low self-esteem may benefit from psychological counseling. Older patients may have more rigid chest walls and bracing may not be effective anymore. Surgery may be considered for cosmetic reasons.

Other Types Of Chest Wall Deformities

Pectus excavatum or funnel chest is characterized by a chest depression, typically at the lower portion of the sternum. This results from abnormal and unequal growth of the rib cartilages that connect the ribs to the sternum. Instead of growing flat on the chest wall, the cartilages grow towards the back, pushing the sternum backward giving the chest a funnel or sunken appearance.

Other chest wall abnormalities may involve abnormal development of the ribs or the sternum. Rib deformities are variable and may include absent ribs, extra ribs, partially developed ribs and fused ribs.

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