History
Parents or the patient may report that pectus carinatum has been present since birth or early childhood, but most children present at age 11-15 years.
The degree of deformity may worsen during adolescence, and most patients are asymptomatic.
Once adult growth has occurred, the severity of the deformity generally remains stable.
Symptomatic patients report exertional dyspnea and tachypnea as well as decreased endurance. In one series, asthmatic symptoms were reported by 22% of patients. [4]
Musculoskeletal chest pain and tenderness when lying in the prone position can also occur. [12]
Patients may be affected by low self-esteem, poor body image, and decreased mental quality of life. [2]
Physical Examination
Fokin et al have proposed the following classifications for pectus carinatum deformities [13] :
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Keel chest (chondrogladiolar variant, most frequent): This is protrusion of the lower third of the sternum, most prominent at the level of the sternoxiphoid junction. It is sometimes associated with lateral depression of the ribs. It may be symmetric or asymmetric. It is also known as pyramidal chest.
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Lateral pectus carinatum (asymmetric variant): This is unilateral protrusion of the elongated costal cartilages, often with concomitant rotation of the sternum towards the opposite side.
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Pouter pigeon breast (costomanubrial variant): This is protrusion of the manubriosternal junction and the adjacent ribs.
Postural abnormalities can occur.
Look for signs of genetic syndromes associated with pectus carinatum. For example, Turner syndrome and Noonan syndrome have been associated with Pouter pigeon breast.
See the image below.
Complications
Lower quality of life and poor body image have been associated with pectus carinatum deformities. [2] Other complications can include the following [14] :
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Exercise intolerance
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Scoliosis, especially when the pectus is asymmetric
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Decreased maximal Inspiratory and expiratory pressures
Also see Complications in the Treatment section.
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Pectus carinatum. Photograph courtesy of K. Kenigsberg, MD.
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Chest radiograph of a patient with pectus carinatum. Radiograph courtesy of A. Fruauff, MD.
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CT scan of a patient with pectus carinatum. CT courtesy of A. Fruauff, MD.
