eMedicine Specialties > Pediatrics: General Medicine > Pulmonology

Pectus Carinatum: Differential Diagnoses & Workup

Author: Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
Contributor Information and Disclosures

Updated: Aug 25, 2008

Differential Diagnoses

Other Problems to Be Considered

Diagnosis of pectus carinatum is clinical and is based on descriptive findings identified during the physical inspection of the chest. Remember that this deformity may occur as an isolated anomaly, in association with congenital heart disease, or with another skeletal anomaly (20% scoliosis). Mixed deformities can be observed in Poland syndrome. Approximately 25% of patients have a positive family history of chest wall deformity. Less frequently, pectus carinatum has been associated with Morquio syndrome, hyperlordosis, and kyphosis.

Workup

Imaging Studies

In pectus carinatum, CT scanning of the chest reveals an increased anterior-posterior chest wall diameter. The Haller method may be used to determine severity index, as follows: width of the chest divided by distance between the sternum and spine at the same level.

Other Tests

  • In patients with pectus carinatum, pulmonary function studies may be tailored to address concerns about clinical symptoms and the appearance of the chest wall upon examination. Data on pulmonary and exercise physiology in patients with pectus carinatum deformities are limited. However, children with barrel chests usually have obstructive ventilatory defects. This underscores the importance of preforming complete pulmonary function testing, including prebronchodilator and postbronchodilator spirometry, lung volumes, and diffusion capacity. Exercise testing may complement these studies.
    • In 1982, Castile described one patient who reported exercise intolerance in his series of symptomatic pectus deformities.5 His pulmonary function studies revealed flow rates and lung volumes within the reference range. Derveaux's 1989 series also reported a patient with no significant respiratory compromise at the time of his study.1
    • Progressive exercise studies may also be helpful in evaluating the exercise-related symptoms and exertional tolerance.
  • Electrocardiography and echocardiography may be considered if congenital heart disease is suspected. Iakovlev's study reported 70 patients with pectus carinatum deformity. Of these, 97% had echocardiographically documented mitral valve prolapse.3 Hemodynamic and cardiodynamic changes were also observed in some patients, as well as decreased myocardial contractility. These abnormalities were more frequently observed in the patients with pigeon breast.
  • Scoliosis series may be considered if clinical features are suggestive of this diagnosis.
  • Chromosomal analysis and metabolic testing may also be considered if other dysmorphic signs are identified.

More on Pectus Carinatum

Overview: Pectus Carinatum
Differential Diagnoses & Workup: Pectus Carinatum
Treatment & Medication: Pectus Carinatum
Follow-up: Pectus Carinatum
Multimedia: Pectus Carinatum
References
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References

  1. Derveaux L, Clarysse I, Ivanoff I, Demedts M. Preoperative and postoperative abnormalities in chest x-ray indices and in lung function in pectus deformities. Chest. Apr 1989;95(4):850-6. [Medline].

  2. Fonkalsrud EW. Surgical correction of pectus carinatum: lessons learned from 260 patients. J Pediatr Surg. Jul 2008;43(7):1235-43. [Medline].

  3. Iakovlev VM, Nechaeva GI, Viktorova IA. Clinical function of the myocardium and cardio- and hemodynamics in patients with pectus carinatum deformity [in Russian]. Ter Arkh. 1990;62(4):69-72. [Medline].

  4. Mielke CH, Winter RB. Pectus carinatum successfully treated with bracing. A case report. Int Orthop. Dec 1993;17(6):350-2. [Medline].

  5. Castile RG, Staats BA, Westbrook PR. Symptomatic pectus deformities of the chest. Am Rev Respir Dis. Sep 1982;126(3):564-8. [Medline].

  6. Frey AS, Garcia VF, Brown RL, et al. Nonoperative management of pectus carinatum. J Pediatr Surg. Jan 2006;41(1):40-5; discussion 40-5. [Medline].

  7. Kobayashi S, Yoza S, Komuro Y, et al. Correction of pectus excavatum and pectus carinatum assisted by the endoscope. Plast Reconstr Surg. Apr 1997;99(4):1037-45. [Medline].

  8. de Matos AC, Bernardo JE, Fernandes LE, Antunes MJ. Surgery of chest wall deformities. Eur J Cardiothorac Surg. Sep 1997;12(3):345-50. [Medline].

  9. Shamberger RC, Welch KJ. Surgical correction of pectus carinatum. J Pediatr Surg. Jan 1987;22(1):48-53. [Medline].

  10. Cano I, Anton-Pacheco JL, Garcia A, Rothenberg S. Video-assisted thoracoscopic lobectomy in infants. Eur J Cardiothorac Surg. Jun 2006;29(6):997-1000. [Medline].

  11. Fonkalsrud EW, DeUgarte D, Choi E. Repair of pectus excavatum and carinatum deformities in 116 adults. Ann Surg. Sep 2002;236(3):304-12; discussion 312-4. [Medline].

  12. Lacquet LK, Morshuis WJ, Folgering HT. Long-term results after correction of anterior chest wall deformities. J Cardiovasc Surg (Torino). Oct 1998;39(5):683-8. [Medline].

  13. O'Neill JA, Fonkalsrud EW, Coran AG, et al. Pediatric Surgery. New York, NY: Elsevier Health Sciences; 1998.

  14. Sabiston D, ed. Textbook of Surgery. Philadelphia, PA: WB Saunders Co; 1997.

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Further Reading

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Keywords

pectus carinatum, bird chest, chicken breast, chondrogladiolar prominence, Pouter pigeon chest, chondromanubrial prominence, carinatum deformity, emphysema, respiratory tract infection, asthma, cystic fibrosis, mitral valve prolapse, Marfan syndrome, congenital heart disease

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Contributor Information and Disclosures

Author

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians
Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Medical Editor

Girish D Sharma, MD, Associate Professor, Department of Pediatrics, Rush University Medical Center, Rush Children's Hospital; Director of Pediatric Pulmonary Section and Rush Cystic Fibrosis Center
Girish D Sharma, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Royal College of Physicians of Ireland
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Charles Callahan, DO, Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center
Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Michael R Bye, MD, Attending Physician, Pediatric Pulmonary Medicine, Columbia University Medical Center; Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons
Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Merck Honoraria Speaking and teaching

 
 
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