Pectus carinatum

This information from Great Ormond Street Hospital (GOSH) is about pectus carinatum (also known as pigeon chest). Pectus carinatum is a condition in which, instead of being level with the ribs, the breastbone (sternum) is ‘pushed out’ so that the middle of the chest is more pronounced. There may also be areas where the rib cage is depressed or ‘pushed inwards’.

In some children and young people, both sides of the ribcage are affected but in others it is asymmetrical with one side more pronounced than the other. Pectus carinatum is more common in boys than girls and affects around one in every 1,500 children.

We are not sure what causes ribcage problems, but it seems to be linked to the cartilage in the ribcage overgrowing. More research is needed to confirm the cause. There may be a genetic link to ribcage problems, as it seems to run in families.

Pectus carinatum may not be obvious in early childhood but becomes more noticeable during growth spurts in adolescence.

Ribcage problems do not usually cause problems when the heart and lungs are developing, but rarely can affect how well they work in later childhood. As the ribcage is more rigid than normal, it can make it difficult to completely breathe out (expire). This can have a ‘knock on’ effect on how well a child can exercise and his or her stamina.

The unusual appearance of the ribcage can also make children self-conscious, although not every child is affected in this way. It is often in teenage years that unusual chest shape is more of a problem, when clothes and appearance become more important.

Pectus carinatum can appear as a symptom of another disorder or syndrome (collection of symptoms often seen together). It can appear as a symptom of Marfan syndrome or osteogenesis imperfecta or sometimes alongside scoliosis (curvature of the spine).

Pectus carinatum can be quite noticeable in adolescence so a physical examination may be all that is needed to confirm the diagnosis. Other tests may include breathing tests to show the effect of the ribcage problem on your child’s breathing.

If the ribcage problems are not causing any physical or psychological problems, a child may not need any treatment.

When ribcage problems are affecting a child’s lung function or are causing serious psychological problems, treatment with surgery may be suggested.

Surgery has good results. In mild cases, no treatment is needed at all. Most children and young people grow up to lead a normal life with no long lasting heart or lung problems.