“After an initial detection by the pediatrician, the medical history and physical examination by the specialist in thoracic surgery are the basis of the diagnosis that will allow the identification of most of these defects. In specific cases, cardiology tests, genetic studies and pulmonary function tests and x-ray or tomography images may be indicated, the latter in the case of a corrective surgical treatment option”, says Dr. Juan Velásquez, thoracic and cardiovascular surgeon from our clinic.

Why is the thorax deformed?

Chest wall deformities usually appear after excessive growth of the costal cartilages that displaces the sternum in or out. The deformity appears and progressively worsens during childhood, with a peak at the onset of puberty. However, they can also occur in the context of other genetic disorders, such as Marfan syndrome, Down syndrome, Edwards syndrome, Morquio syndrome (dwarfism), osteogenesis imperfecta (excessively brittle bones), among other syndromes.

What are thoracic malformations?

The most common are pectus excavatum (sunken chest) and pectus carinatum (pigeon chest). Of these, sunken chest represents between 80 and 90% of all chest wall deformities, occurs in 1 in 400 to 1,000 newborns, and is 3 to 5 times more frequent in males than in females.

Are there any warning signs?

The vast majority are asymptomatic. Some children may report reduced exercise tolerance, heartbeat or palpitations, shortness of breath, or chest pain. The specialist will assess whether any auxiliary tests will be necessary.

Do chest malformations cause any complications in children?

The main complication is related to growth and development, in which pectus carinatum or excavatum are more marked in puberty and adolescence, causing aesthetic concern and eventual psychological affectation that can cause social isolation and an inadequate relationship with the environment.

What is the treatment and what results does it provide?

Treatment will depend on the type of thoracic malformation diagnosed by the thoracic surgeon, who will assess the severity of the malformation, being able to indicate anything from conservative treatment to the possibility of surgical correction. Surgical correction ranges from open surgery with resection of costal cartilages and repositioning of the sternum (Ravitch Technique), the placement of corrective metallic prostheses (endothoracic bar or Nuss Technique) or other variants, depending on what is required. The results of corrective surgery are very satisfactory and remarkable.

Dr. Juan Velásquez
Thoracic and Cardiovascular Surgeon at Clínica Ricardo Palma