Pectus
Carinatum

Pectus Carinatum (PEK-tus kair-ih-NOT-um), also known as pigeon chest, is a rare chest wall deformity that causes the breastbone to push outward instead of being flush against the chest. This is caused by the unusual growth of rib and breastbone (sternum) cartilage.

WHAT ARE THE CAUSES?

The cause is generally unknown, and most often, pectus carinatum develops during childhood and gets more pronounced as children go through puberty. In some cases, it may not be noticeable until a child goes through an adolescent growth spurt, and the appearance may be worse on one side, with the opposite side appearing to have a dip or indent in it – hollowed out in appearance.

ASSOCIATED
medical conditions

TWO BASIC TYPES
OF PECTUS CARINATUM

Chondrogladiolar prominence, also called “chicken breast” is the most common form of the condition which accounts for nearly 95 percent of pectus carinatum cases. Here, the middle and lower sections of the breastbone will push forward.

Chondromanubrial prominence, also known as pouter pigeon breast, is a rare type of pectus carinatum which is more complex to treat. Here, the breastbone will develop in a Z-shape, with the top section pushing forward.

HOW IS PECTUS CARINATUM
DIAGNOSED?

PC is often diagnosed by physical exam – the most obvious sign is the physical appearance of the chest. An x-ray (of the front view and side view) may be used to exclude bony deformity or underlying problems.

Pectus Carinatum

WHAT ARE THE
TREATMENT OPTIONS?

Although the condition is mainly cosmetic, some children and adolescents may experience symptoms and side effects. The treatment would be based on appearance as well as the symptoms experienced. A common association with PC (Pectus Carinatum) is Scoliosis, or Hyper Kyphosis, which are spinal deformities that could range from mild to severe. Should both conditions (spinal and chest deformity) be picked up, they would need to be treated simultaneously.

The standard treatment approach for pectus carinatum in children with a mild to moderate form of the condition is orthotic bracing, where a custom-fitted brace is fitted on the outside of the chest.

The purpose of the brace is to place pressure on the area most affected by the condition, to flatten it to the chest, which is called remodeling. For effective treatment, a child would need to wear a brace full time for the first three to twelve months. The wear-time of the brace would decrease, based on the doctor’s instructions, and as the corrections are made after this initial period. A child may need to wear the brace until they have gone through puberty.

Medical practitioners will often tell patients that it is not necessary to treat PC, but in most cases, the psychological effects of the deformity would justify treatment. In most cases, brace treatment is effective and the associated physiotherapy.

Surgery is usually only an option for people when a chest brace has been ineffective or when they have passed puberty. A doctor may also consider surgery for people whose symptoms are severe. Surgery is more commonly performed in the Pectus Excavatum (caved-in chest) where bracing is usually ineffective. In most cases, a child’s health is not affected by pectus carinatum, and treatment with a chest brace tends to have good results.

Supporting Children with Pigeon Chest

FREQUENTLY ASKED
QUESTIONS

What is pigeon chest, or pectus carinatum?

Pectus carinatum, also known as Pigeon Chest, is a condition where the breastbone sticks out more than usual, caused by the unusual growth of rib and breastbone (sternum) cartilage.  While the chest wall is developing, the cartilage that connects the ribs will normally grow flat along the chest. In cases of pectus carinatum, this cartilage would grow abnormally, causing unequal growth in the areas where the ribs connect to the sternum (breastbone) causing bulging, which gives the chest a birdlike appearance, or pigeon chest.

Can pectus carinatum (pigeon chest) be corrected?

Orthotic treatment using a chest brace is often an effective treatment for children with pectus carinatum (pigeon chest). The brace will put gentle pressure on the chest to change the shape and position of the breastbone (sternum) over time, which will reverse the outward appearance. 

 

Your child will need to wear the brace every day. Treatment may take up to 2 years depending on the severity of the pigeon chest. For the treatment to be effective, it’s important that your child wears the brace as directed by the Orthotist. The more hours they spend wearing the brace, the more likely it is to be successful.

Can pigeon chest cause complications?

In most cases of pectus carinatum (pigeon chest), patients don’t have any other problems. The condition is mainly cosmetic, but some children and adolescents may experience symptoms and side effects from pectus carinatum. In some cases, a patient with this chest deformity may also have scoliosis. Should your child have pigeon chest as part of a genetic disorder like Marfan syndrome or Noonan syndrome, there may be a range of other symptoms. 

 

Although some medical practitioners may tell the parents of patients that it is not necessary to treat PC (pectus carinatum), the psychological effects of the deformity would justify treatment. In most cases, brace treatment is effective with the associated physiotherapy.

Does pigeon chest, pectus carinatum, get worse with age?

Pectus carinatum is unlikely to get better by itself and can often worsen during the growth spurt that comes with adolescence. The appearance of the deformity may get worse in early adolescence and could continue to get worse into adulthood. Pigeon chest doesn’t halt until the bones stop growing which is usually around 18 years of age. 

What causes pigeon chest?

Pectus carinatum is believed to be a disorder of the cartilage that joins the ribs to the breastbone, also known as the sternum, and the exact cause of this condition is unknown. It usually first develops during a rapid growth spurt in children and adolescents aged ten years and older. Pigeon chest can sometimes be hereditary (running in the family), and in some patients, pectus carinatum may be associated with Marfan syndrome, which is a connective tissue disorder.

How would I know if my child has pectus carinatum?

Pectus carinatum, also known as pigeon chest, is a deformity where the breastbone and ribs push outward. It is often asymmetrical, where one side of the chest is affected more than the other. Most children with a  pigeon deformity don’t have symptoms other than the chest starting to stick out. The condition usually starts to develop at the age of 10 or older.