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5/25/23 blog post

when to be concerned about a chest wall malformation

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Chest wall malformations are a group of congenital deformities that affect the development of the chest wall, resulting in an abnormal shape or structure. These malformations can impact an individual's respiratory function, growth and overall quality of life. While most cases are asymptomatic, parents should be aware of the symptoms that may need further evaluation. Arturo Aranda, MD, FACS, CPE, division chief of pediatric surgery shares his guidance on when to seek medical attention for a chest wall malformation.

what are the most common types of chest wall malformations?

There are several types of chest wall malformations, but the two most common among children are pectus carinatum and pectus excavatum.

  • Pectus carinatum: A genetic condition that makes the chest bulge out. This happens because of an unusual growth of rib and breastbone (sternum) cartilage. The bulging gives the chest a birdlike appearance. The condition is sometimes called pigeon breast or pigeon chest.
  • Pectus excavatum: A medical condition where the chest sinks inwards, giving it a sunken or caved-in appearance. It is also known as funnel chest or sunken chest. This occurs due to an abnormal growth of cartilage that connects the ribs to the breastbone (sternum). The growth causes the sternum to curve inward. Although kids are born with it, it may not be noticeable for the first few years or sometimes even until the teenage years. Mild cases might be barely noticeable.

how are chest wall malformations treated?

Treatment for chest wall malformations varies based on the type and severity.

pectus carinatum

Kids and teens with mild pectus carinatum might not have breathing problems or worry about their appearance. If so, they don't need treatment.

Kids whose bones are still growing can wear a chest brace. Much like how braces realign teeth, a chest brace will push the breastbone back to a normal position. They can remove it for sports, showering and other activities, but typically need to wear it for at least 23 hours a day at first and then a minimum of 8 hours a day once the initial phase has concluded.

The bracing technology utilized by Dayton Children's surgery team is custom-made for each patient and adjusted using a pressure monitor. Previously, any adjustment had to be made without any reference. Now, adjustments are made with the help of a pressure-measuring device that measures compression of the chest in pounds per square inch (PSI), which makes the correction faster and safer. It's also easier to wear, less bulky and has to be worn for only half the amount of time compared to traditional bracing.

pectus excavatum

Pectus excavatum can cause limitations to exercise and other physical activities or be completely harmless if it's not affecting how the lungs or heart work. Surgery often can correct the condition and treat any heart or lung issues. Physical therapy and exercises to strengthen muscles are also helpful. Dayton Children's offers both surgical and non-surgical treatment options for kids with pectus excavatum.

  • Vacuum bell: Designed for the non-surgical treatment of pectus excavatum, a vacuum bell is placed on the front of the chest and a pump is used to suck the air out of the device. This creates suction, or a vacuum, that pulls the chest and breastbone forward. Over time, the chest wall and breastbone stay forward on their own and hold a new shape.
  • Nuss procedure: To repair pectus excavatum, appropriate patients may undergo surgery that involves the Nuss procedure. The Nuss procedure involves placing a titanium or steel bar under the sternum to exert pressure to correct the chest deformity. The procedure itself is minimally invasive and requires two to three incisions. The bar is removed three years later, once the deformity has corrected itself and becomes permanent. Ideally, this surgery is performed on patients ages 12-14. Any younger and the procedure would have to be repeated, and much older, the bones have hardened, making correction more difficult.

when should I seek medical attention for my child?

As mentioned earlier, some chest wall malformations can cause respiratory distress, chest pain or mental health concerns that need further evaluation.

Parents should be concerned and seek medical attention if their child experiences:

  • Difficulty breathing, especially with exercise or during sleep
  • Chest pain or discomfort
  • Anxiety in situations where the chest is exposed, such as swimming

These symptoms may indicate that the chest wall malformation is causing significant functional impairment or affecting the child's overall health.

If you suspect your child may be affected by a chest wall malformation, schedule an appointment online.

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Arturo Aranda pediatric surgeon
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Arturo Aranda, MD, FACS, CPE

division chief surgery
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