When the cartilage in between the ribs grows abnormally and causes the chest to protrude forward.
Understanding Pectus Carinatum
Pectus carinatum is a chest wall condition in which the cartilage in between the ribs grows abnormally and causes the chest to stick out or protrude forward. It is more common in boys than girls, and it tends to become more noticeable as a child approaches puberty and periods of rapid growth. It can often be seen with the naked eye, causing the child or parents to bring it up to the pediatrician or other physician who might order an x-ray for confirmation.
Pectus carinatum can sometimes be hereditary. It may also correlate with other conditions such as Marfan syndrome, Ehlers-Danlos syndrome, metabolic conditions, or chromosomal abnormalities. Symptoms may include shortness of breath, chest pain or tenderness, increased respiratory infections, and fatigue. The most common complication is shortness of breath, especially with exercise. However, this condition is often more cosmetic that symptomatic.
The most common treatment for pectus carinatum is the use of a compressive brace during times of growth. This brace wraps around the chest and applies a light, gradual pressure over the projected area to reshape the chest wall while the patient is growing. This can be custom-made or off-the-shelf, depending on the child’s body shape and location of the projected area. The amount of correction achieved directly relates to the amount of time the child wears the brace. Ideally, they will wear the brace 16 to 23 hours a day through their adolescent growth spurt. As the chest wall reshapes and the patient grows, follow-up appointments will be necessary to make sure the brace continues to fit and function correctly.
Research has shown that patients who wear their brace for the prescribed amount of time have significant improvement in appearance and long-term correction, eliminating the need for surgical intervention. If left untreated, pectus carinatum can progress, becoming more noticeable and permanent as a person reaches skeletal maturity. Once a patient has finished growing and has reached skeletal maturity, an orthotic brace is no longer an effective treatment and surgical intervention may be an option.
Jung, Joonho et al. “Brace compression for treatment of pectus carinatum.” The Korean journal of thoracic and cardiovascular surgery vol. 45,6 (2012): 396-400. doi:10.5090/kjtcs.2012.45.6.396 | Lee, Richy T et al. “Bracing is an effective therapy for pectus carinatum: interim results.” Journal of pediatric surgery vol. 48,1 (2013): 184-90. doi:10.1016/j.jpedsurg.2012.10.037 | Moon, Duk Hwan et al. “Long-Term Results of Compressive Brace Therapy for Pectus Carinatum.” The Thoracic and cardiovascular surgeon vol. 67,1 (2019): 67-72. doi:10.1055/s-0038-1669927
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