Understanding Pectus Carinatum or Pigeon Chest for Parents

What is Pectus Carinatum?

Pectus carinatum (also known as Pigeon Chest or Keel Chest), is an abnormality resulting in an overgrowth of the cartilage forming the breastbone. This can result in the breastbone region sticking out from the remainder of the chest. The name pectus carinatum comes from the Latin “chest keel”, referring to the keel of ancient Roman ships.[1] Pectus carinatum is usually diagnosed by a doctor following a careful physical examination. There are two main types of this condition: Chondrogladiolar prominence (where the middle and lower sections of the breastbone protrude) and Chondromanubrial prominence (where the upper section of the breastbone protrudes). The latter type is generally more severe.

What Causes Pectus Carinatum?

Pectus carinatum is a congenital condition, meaning that the condition is present before birth (even if the symptoms are not obvious until later years). However, its exact cause is unknown. There appears to be a genetic component, as around 25% of patients with pigeon chest also have a family member with the condition.[2] It has been suggested by some authors that multifactorial inheritance is at play, meaning that genetic, environmental, and random factors may influence its presence in a given person. [3] Pectus carinatum sometimes occurs in association with other syndromes, most commonly Marfan Syndrome or Noonan Syndrome. It is four times as common in males as females.[3]

What Are the Symptoms or Signs of Pectus Carinatum?

Over 90% of pectus carinatum cases are not diagnosed until at least 10 or 11 years of age, when the rapid growth spurt during puberty makes the symptoms more noticeable.[4] However, there are several symptoms/signs which may provide early warning of pectus carinatum cases, including:

• Irregularities in the breastbone region or jutting of the chest. This is the most common and characteristic symptom; however, it is often among the last to develop. 
• Lateral curvature of the spine (scoliosis) or outward curvature of the spine (kyphosis)
• Poor posture, including hunching of the upper back and rounded or hooked shoulders.
• Shortness of breath or rapid breathing. Some people may experience trouble breathing, particularly during exercise. Up to 25% of teenagers with pectus carinatum report experiencing asthma-like symptoms. 
• A fast heartbeat (tachycardia). This results from compression of the chest region in severe cases of pigeon chest. 
• Chest pain. Again, this usually only occurs in severe cases. 
• Feeling fatigued and lethargic.

How Parents Can Care for Pectus Carinatum

Does your child have pectus carinatum? If you are in the early stages following a diagnosis, it can be an overwhelming experience and you may be unsure what to do.

The most important thing is to stay calm and not panic. Pectus carinatum is the second most common chest abnormality, occurring in 1 in every 1500 births (0.07%)[5]; meaning that over 100,000 people in the United States are living with this condition. However, some studies have suggested that the true incidence of pectus carinatum may be higher than previously thought. One study from Brazil reported that 0.7% of middle schoolers surveyed had pectus carinatum.[6] Similarly, an incidence rate of 0.6% has been reported for middle school students from Turkey.[7]

It is also important to note that pectus carinatum does not normally affect the development or function of internal organs such as the heart or lungs, except in the most severe cases. Most people with the condition primarily suffer from cosmetic issues and poor self-perception.[1]

Furthermore, the treatment methods and patient outcomes for pectus carinatum have advanced significantly in recent years. The use of orthotic bracing is now preferred as the first treatment method.[8] This involves wearing a lightweight brace that applies pressure around the chest/breastbone region. Over time, this can remodel the growth pattern of the cartilage forming the breastbone, correcting the outgrowth.[9] Several studies have demonstrated that orthotic bracing is a suitable and effective treatment method for most patients, 8-12 with positive results usually obtained in 6-12 months.

Historically, surgery was the primary treatment method for pectus carinatum, but is now only recommended for severe cases or situations where orthotic bracing fails. This is fortunately quite rare, with clinical studies suggesting that only 2-11% of patients fail to respond to bracing treatment. [9] 

What is required for effective bracing treatment?

To be effective in treating pectus carinatum, the brace must be well-suited to your child’s chest shape and worn as prescribed by a health professional. Many generic braces for pectus carinatum are available on sites such as eBay or AliExpress; however, these are often low-quality products and are not custom-designed. Consequently, they can take much longer for results or could even worsen the condition. Furthermore, pectus carinatum braces must be worn for long periods (usually 23 hours) every day for effective results. If the brace is not comfortable and well-suited to your child’s body shape, they are unlikely to want to wear them and the condition may relapse.

This is where custom braces produced by Dakota Brace can help. These braces are 3D printed to perfectly fit a 3D scan of your child’s body shape and ensure their comfort. The team of certified clinicians provides expertise and support at every step of the process. Even better, everything can be done remotely* in a way that fits your schedule, yet never compromises on quality.

*Note: You will need access to an iPhone X or later to do your initial scan. This can be borrowed for the initial 45-minute scanning consultation.

Conclusion

Are you ready to restore your child’s health and confidence? Do you need more information about how to fix pectus carinatum?

Click here for your free consultation and get $75 off your first order, and get evaluated for either our Custom Pectus Brace (The Dakota Brace) or our Custom Pectus & Two Rib Flare Brace (The Bison Brace).

References

1. Özkaya, M., & Bilgin, M. (2018). Minimally invasive repair of pectus carinatum: a retrospective analysis based on a single surgeon’s 10 years of experience. General Thoracic and Cardiovascular Surgery, 66(11), 653-657.
2. Shamberger, R. C. (1996). Congenital chest wall deformities. Current Problems in Surgery, 33(6), 469-542.
3. Cobben, J. M., Oostra, R. J., & van Dijk, F. S. (2014). Pectus excavatum and carinatum. European Journal of Medical Genetics, 57(8), 414-417.
4. Fonkalsrud, E. W. (2008). Surgical correction of pectus carinatum: lessons learned from 260 patients. Journal of pediatric surgery, 43(7), 1235-1243.
5. Robicsek F, Watts LT. Pectus carinatum. Thorac Surg Clin. 2010;20:563–74.
6. Westphal, F. L., Lima, L. C. D., Lima Neto, J. C., Chaves, A. R., Santos Júnior, V. L. D., & Ferreira, B. L. C. (2009). Prevalência de pectus carinatum e pectus excavatum em escolares de Manaus. Jornal Brasileiro de Pneumologia, 35, 221-226.
7. Coskun, Z. K., Turgut, H. B., Demirsoy, S., & Cansu, A. (2010). The prevalence and effects of pectus excavatum and pectus carinatum on the respiratory function in children between 7–14 years old. The Indian Journal of Pediatrics, 77(9), 1017-1019.
8. Emil, S. (2018). Current options for the treatment of pectus carinatum: When to brace and when to operate?. European Journal of Pediatric Surgery, 28(04), 347-354.
9. Lee, R. T., Moorman, S., Schneider, M., & Sigalet, D. L. (2013). Bracing is an effective therapy for pectus carinatum: interim results. Journal of Pediatric Surgery, 48(1), 184-190.
10. Cohee, A. S., Lin, J. R., Frantz, F. W., & Kelly Jr, R. E. (2013). Staged management of pectus carinatum. Journal of Pediatric Surgery, 48(2), 315-320.
11. Colozza, S., & Bütter, A. (2013). Bracing in pediatric patients with pectus carinatum is effective and improves quality of life. Journal of Pediatric Surgery, 48(5), 1055-1059.
12. Lee, S. Y., Lee, S. J., Jeon, C. W., Lee, C. S., & Lee, K. R. (2008). Effect of the compressive brace in pectus carinatum. European Journal of Cardio-Thoracic Surgery, 34(1), 146-149.