eMedicine Specialties > Pediatrics: General Medicine > Pulmonology

Pectus Carinatum: Treatment & Medication

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

Treatment

Medical Care

In treating pectus carinatum, both dynamic chest compressors and body casting have been described in limited series and a case report.

  • A retrospective study by Frey et al reported success with orthotic bracing in a group of 29 children with chondrogladiolar pectus carinatum, using bracing 14-16 h/d until completion of linear growth or a minimum of 2 years.6  Compliance rate with bracing in this group of children was 90%. Frey et al recommend nonoperative management and bracing as first-line treatment for children with this type of pectus carinatum.
  • The ideal candidate is a motivated, skeletally immature child with a mild deformity.
  • Casting followed by bracing or bracing alone eliminates the risks of surgery and anesthesia and does not preclude surgery if unsuccessful.

Surgical Care

  • Endoscopic resection of costal cartilage with a sternal osteotomy
    • Because many corrections are performed for cosmetic reasons, decreasing the size of incisions is important.
    • In 1997, Kobayashi reported 2 patients in whom the pectus carinatum deformity was corrected with limited incisions using an endoscopic approach.7 They suggest that this approach is better indicated in preschool-aged children because of their skin quality and tone, as well because of the increased ease of costal dissection compared with adult patients.
    • In 2008, Fonkalsrud reported a series of 260 patients who underwent surgical correction of pectus carinatum deformities over a period of 37 years.2 He concluded that, over time, the trend towards less extensive open techniques has resulted in "low morbidity, mild pain, short hospital stay and very good physiologic and cosmetic results." His study included both pediatric and adult patients.
  • Open surgical repair
    • Various methods have been described.
    • The reader is referred to Fonkalsrud (2008),2 de Matos (1997),8 or Shamberger (1987)9 for further details.

Consultations

  • Pectus carinatum has been associated with congenital heart disease. In these patients, and in those with suspected or identified cardiac pathology, preoperative cardiology evaluation is recommended.
  • Exercise testing may be performed in consultation with either a cardiologist or a pulmonologist.
  • Symptomatic patients with exertional dyspnea, tachypnea, or decreased endurance, as well as those with asthma symptoms, benefit from a pulmonology evaluation.

Activity

Symptomatic patients may report decreased exercise tolerance and exertional dyspnea, which may limit activity. Fonkalsrud's series (2008) reported improvement in exertional symptoms and endurance in all symptomatic patients within 3-6 months of surgical repair.2  

Fonkalsrud's recommendations for postoperative activity include the following:2

  • Use incentive spirometer and encourage periodic deep breaths.
  • Limit twisting movements of the chest for at least 4 months postoperatively.
  • Avoid rapid elevation of the arms overhead for at least 4 months postoperatively.
  • Encourage lower extremity exercise (may begin within first 2 wk after surgery).
  • Light weights may be used to strengthen biceps and deltoids; the use of chest and abdominal muscles may be increased later (after 3-4 wk).
  • Gym classes are not indicated for 5 months after surgery in school-aged children.
  • Long-term recommendations include stretching exercises that involve pulling the shoulder blades posteriorly to improve posture.

Medication

Drug therapy currently is not a component of the standard of care in pectus carinatum. See Treatment.

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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