Funnel chest

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Alternative names
Pectus excavatum

Definition
Pectus excavatum is the descriptive term for an abnormal formation of the rib cage, in which the distance from the breastbone (sternum) to the backbone (vertebrae) is decreased, giving the chest a caved-in or sunken appearance.

Considerations
Pectus excavatum is a congenital abnormality that can be mild or severe. The child typically has a depression in the center of the chest over the sternum, and this may appear quite deep. It is caused by excessive growth of the costosternal cartilage (the connective tissue joining the ribs to the breastbone), which causes an inward deformity of the sternum.

If pectus excavatum is severe, it may affect the heart and lungs, making exercise difficult. Also, the appearance of the chest may cause psychological difficulty for the child.

Pectus excavatum may occur as the only abnormality, or in association with other syndromes.

Common Causes

• Isolated defect (i.e., not associated with other problems)
  
• Familial pectus excavatum
  
• Marfan’s syndrome
  
• Rickets

Call your health care provider if

• Trouble breathing develops
  
• You note decreased exercise tolerance
  
• Chest pain
  
• Redness, swelling, or discharge from the area is noticed
  
• Pectus excavatum should be discussed with your health care provider at each regular visit

What to expect at your health care provider’s office
The medical history will be obtained and a physical examination performed.

Medical history questions documenting pectus excavatum in detail may include:

• When did you first notice this?
  
• Is it getting better, worse, or staying the same?
  
• Have any other family members had an unusual-shaped chest?
  
• What other symptoms are present?

Physical examination:
An infant with pectus excavatum may have other symptoms and signs that, when taken together, define a specific syndrome or condition.

DIAGNOSTIC TESTS:
Laboratory studies such as chromosome studies, enzyme assays, X-rays, or metabolic studies may be ordered to confirm the presence of a suspected disorder.

Intervention:
This condition can be surgically repaired. Surgery is generally advised if associated problems such as difficulty with exercise develop. In addition, some people undergo surgery for cosmetic reasons. Your health care provider can assist you in making decisions about therapy.

After seeing your health care provider:
If a diagnosis was made by your health care provider related to pectus excavatum, you may want to note that diagnosis in your personal medical record.

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