Pectus carinatum is a deformity characterized by anterior protrusion of the sternum, often accompanied by depression of the costal cartilages and ribs on both sides. It is the second most common chest wall deformity, following pectus excavatum. The etiology of pectus carinatum remains uncertain, although it is thought to have a genetic component, with approximately 20%–25% of patients reporting a family history of the condition.
It is generally believed that the deformity results from excessive growth of the ribs and costal cartilages, with the sternal deformity being secondary to rib abnormalities. In some cases, it may also be secondary to intrathoracic diseases.
Clinical Presentation
In most cases, pectus carinatum is difficult to detect during infancy and early childhood, often becoming noticeable only after the child reaches the age of five or six. Mild deformities typically do not affect cardiopulmonary function and are asymptomatic. Severe cases may lead to an elongated anteroposterior diameter of the thoracic cavity, reducing respiratory excursion and decreasing lung elasticity. Symptoms such as shortness of breath and fatigue can occur. Affected children are often prone to recurrent upper respiratory tract infections and asthma and may exhibit reduced physical endurance and increased fatigue. Many patients experience significant psychological stress due to the chest wall deformity, often leading to feelings of inferiority.
The main physical findings include anterior protrusion of the chest wall, increased anteroposterior chest diameter, and kyphosis. Severe cases with pronounced deformities are usually easy to diagnose clinically. Lateral chest X-rays clearly demonstrate the sternal deformity, while chest CT scans provide further diagnostic insights and help identify any associated abnormalities involving the chest or cardiovascular systems.
Treatment
Treatment for pectus carinatum includes physical exercises for body shaping, corrective thoracic wall dynamic compression devices, and surgical interventions. Mild cases may benefit from physical fitness activities, particularly swimming, which can aid in correcting the deformity. Patients with moderate to severe deformities can utilize chest wall dynamic compression devices in combination with exercise-based correction. Early intervention with corrective treatment is often effective in children with pectus carinatum, although recurrence may occur, necessitating long-term use of the device. Cases that are unresponsive to conservative treatment or involve severe deformities require surgical correction. Conventional surgical methods include sternal turnover and sternal sinking procedures. In recent years, minimally invasive surgery for pectus carinatum (referred to as the reverse Nuss procedure) has shown promising therapeutic outcomes.