Pectus carinatum

What is pectus carinatum?

Pectus carinatum is a condition where the breastbone (sternum) pushes outward due to excess cartilage growth. It’s a congenital condition, meaning it’s present from birth, but it often becomes more noticeable during adolescence as the body grows. It’s sometimes referred to as ‘pigeon chest.’

Often, both sides of the ribs are affected. In other cases, it can appear asymmetrical, with one side more noticeable than the other.

It is not to be confused with pectus excavatum, when the chest sinks inward.

Symptoms

• breastbone looks pushed out: in the middle of your chest
• chest asymmetry: one side may stick out more than the other.
• rib flaring: your lower ribs may stick outward, exaggerating your chest shape

It is possible to have a chest shape that has characteristics of both pectus carinatum and excavatum, where part of the chest protrudes, whereas the other dents inwards.

The severity and appearance of the condition can vary from person to person.

Psychological impact

Patients can find the psychological aspect of having pectus carinatum the hardest to deal with.

Many patients, especially teenagers, may worry about their appearance and about others noticing their chest shape. This can lead to:

• social anxiety
• body image issues
• feeling more self-conscious
• low confidence
• low self-esteem
• withdrawal from activities you used to enjoy, for example swimming

Causes

The exact cause of pectus carinatum is not fully understood, but it’s mainly because the cartilage between the ribs and the breastbone grows too much, pushing the breastbone outward.

There’s thought to be a genetic factor as it often runs in families, but the specific gene that causes it hasn’t been found yet. Sometimes, pectus carinatum is also linked to other conditions like scoliosis or Marfan syndrome.

Diagnosis

Assessment and diagnosis should be carried out by a GP or appropriately qualified healthcare professional.

This may involve a physical examination and, where appropriate, imaging such as X-rays or CT scans to assess the severity and rule out other conditions.

Treatment

Treatment options vary from person to person and may depend on factors such as:

• your age
• how severe your pectus carinatum
• the flexibility of your chest

Non-surgical management

Non-surgical options may be considered for some individuals following clinical assessment.

• Dynamic chest compressor: a custom-made orthotic brace designed to apply controlled pressure to gradually reshape the chest over time as part of a structured treatment programme
• Rib flaring brace: a bespoke brace designed to apply targeted pressure to the rib cage as part of a combined approach

Surgical treatment

Surgical procedures may be considered in some cases and are typically discussed with a specialist.

Ravitch procedure or modified Ravitch procedure: surgery that involves making an incision across the chest and removing the excess rib cartilage on each side, before repositioning the breastbone to a flatter position.

Non-surgical bracing may be appropriate for some individuals, while others may be referred for surgical opinion depending on their presentation.

See our pectus carinatum treatment page