eMedicine Specialties > Pediatrics: General Medicine > Pulmonology

Pectus Carinatum: Follow-up

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

Follow-up

Further Inpatient Care

  • For information regarding these indications in pectus carinatum, see Activity.

Further Outpatient Care

  • Long-term activity recommendations include stretching.

Complications

  • Complications vary according to treatment selection.
  • Shamberger reported a 3.9% complication rate with open surgical repair.9 Complications include pneumothorax (2.6%), wound infection (0.7%), atelectasis (0.7%), and local tissue necrosis (0.7%). The mean postoperative stay was 5.8 days.
  • Fonkalsrud (2008) reported shorter hospital stays (mean, 2.6 d), mild postoperative pain, and low complication rate with limited resection and immediate chest stabilization.2

Prognosis

  • Frey et al reported success with nonoperative management of pectus carinatum (chondrogladiolar type) in a small number of patients.6
  • Excellent results (97.4%) have been reported by Fonkalsrud (2008) in patients who underwent surgical correction using a very limited resection of deformed cartilage and immediate chest stabilization.2 In addition, he reported less postoperative pain, shorter hospital stays, lower complication rate, and decreased cost. Furthermore, he reported satisfactory cosmetic results with the less extensive repair, as well as a high rate of improvement in exertional symptoms compared with more extensive open surgical procedures.

Patient Education

  • Exertional symptoms may develop with pectus deformities and may not always be identified with standard pulmonary function testing.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose pectus carinatum
  • Failure to recognize the association of dyspnea and poor endurance with pectus carinatum deformity
  • Failure to recognize that surgical options may be beneficial even after skeletal maturity has occurred

Special Concerns

  • In adults with functional impairment and severe pectus deformities who did not undergo surgical intervention as children, repair during adulthood is currently an acceptable treatment option.
 


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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