Ask the Pediatric Surgeon

Dr Soukup Elliot Hospital

Dear Dr. Soukup,

My 14 year-old son has gone through a growth spurt in the past few months and I noticed this summer at the beach that his chest seems “sunken” to me. Why does it look this way? Is it dangerous? Thanks for your help, Caroline 

Dear Caroline, 

Your question is perfectly timed! Dr. Meghna Misra is a pediatric surgeon that just joined us at the Elliot Hospital and has special expertise in this problem, so I have asked her to answer your question: Your son likely has a condition called Pectus Excavatum, also called “sunken chest” or “funnel chest” to describe its appearance. Pectus excavatum is the most common chest wall anomaly that we see in teenage boys. It happens in boys 4 times more frequently than it happens in girls, approximately once in every 400 births. It also can run in families. Pectus excavatum develops when the rib cartilage grows with an abnormal shape where it connects to the sternum (breast bone). Frequently, the depression of the chest wall starts in the first years of life, but is often overlooked at that age. Typically, it isn’t until kids undergo the rapid growth of puberty that families start to notice the change in the chest wall appearance.

Rest assured, pectus excavatum is not dangerous and does not cause problems with lung or heart function. However, it is not uncommon for kids with pectus excavatum to complain of chest pain, shortness of breath, or some degree of exercise intolerance. Some adolescents don’t have any physical symptoms from the pectus – but may suffer from the psychological impact of their chest wall appearance that can significantly impair their quality of life. I would recommend for your son to undergo evaluation by a pediatric surgeon.

With a combination of a physical exam and low-dose radiation studies, the surgeon will be able to assess the severity of the pectus and determine whether or not your son may benefit from corrective surgery. The most common intervention for pectus excavatum is called the “Nuss Procedure” which is a minimally invasive technique in which a bar is placed behind the sternum to correct the chest wall depression. Adolescents tend to do very well with this operation, but again, it is not necessary for all patients with pectus excavatum. Even if the decision is not to have surgery, he can be followed with physical exams until the adolescent period is over.

The other common chest wall deformity is called “Pectus Carinatum” in which the sternum is pushed outwards. This is most often managed with brace therapy that is well tolerated by kids. Thanks for your question! 

Sincerely, Dr. Misra and Dr. Soukup #askthepediatricsurgeon 

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