A keel chest, also known as a funnel chest or pigeon chest, is a keel-shaped protrusion of the sternum. People with pectus carinatum often experience psychological distress as a result. However, pectus carinatum is not medically problematic. Those affected usually undergo treatment for aesthetic reasons.
Further information and a list of selected pectus carinatum specialists can be found below.
What is a pigeon chest?
Pectus carinatum is a keel-shaped protrusion of the sternum. It is the second most common congenital chest deformity in children. Doctors distinguish between symmetrical and asymmetrical forms of pectus carinatum:
- In symmetrical pectus carinatum, both sides of the sternum protrude evenly.
- In asymmetric pectus carinatum, however, the protrusion is more pronounced on one side. It is even possible that one of the two sides is barely affected or not at all.
Causes of Pectus Carinatum
The exact causes of pectus carinatum (the medical term for pigeon chest) are disputed. However, there is a generally accepted explanation. This suggests that pectus carinatum is caused by excessive growth of the cartilaginous joints in the chest area (connections between the sternum and the ribs).
Only in rare cases is a predisposition to pectus carinatum present at birth. In most cases, pectus carinatum develops during the growth phase of childhood. In addition, the deformity appears to occur more frequently in certain families. However, scientists have not yet been able to determine the exact pattern of inheritance. Boys are affected more often than girls.
Among the most well-known chest deformities are funnel chest (pectus excavatum) and pigeon chest @ Pepermpron /AdobeStock
In some cases, pigeon chest occurs as a complication of another disease. The following primary conditions can cause the chest area to protrude:
- Mucopolysaccharidosis
- Thoracic emphysema
- Marfan syndrome
- Scoliosis
Symptoms of Pectus Carinatum
Patients with a pigeon chest often experience psychological distress due to their physical deformity. Teasing or strange looks are a daily occurrence for them. As a result, a pigeon chest often has a negative impact on patients’ self-esteem and self-confidence. This emotional distress is usually the reason why those affected seek medical attention.
However, medical problems can also arise in connection with pectus carinatum. For example, some patients are unable to sleep due to pain. Those who sleep on their stomachs, in particular, wake up several times a night because of the pain.
They are usually prescribed pain medication to help them sleep through the night again. Furthermore, pain can also result from local trauma to the sternum.
Treatment of Pectus Carinatum
The following treatments are available for pectus carinatum:
- Conservative: Doctors use a compression bandage (pelotte) for children.
- Open surgery: After puberty, patients can undergo surgery to correct pectus carinatum.
- Minimally invasive: Alternatively, patients can opt for the MIPCR (Minimally Invasive Pectus Carinatum Repair) procedure. In the MIPCR procedure, doctors implant a metal bar that pushes the carina downward.
Conservative Treatment of Pectus Carinatum
A compression bandage (pelotte) is used as a conservative treatment, particularly for young patients who are still growing. The pelotte is a compression bandage designed to push the sternum back into place by applying constant external pressure.
This method can only be used if the chest area has not yet fully matured and hardened. Due to the constant pressure, the pelotte is associated with pain and discomfort.
Surgical Treatment of Pectus Carinatum
Surgical treatment is performed by pectus carinatum specialists. Surgery is recommended when the chest cannot be pushed back in, that is, when the patient has reached the end of the pubertal growth phase.
In open surgery, doctors expose the chest wall to gain access to the cartilaginous connections. They then remove the cartilaginous connections and push the sternum back into its original position. Doctors fix and secure the sternum in its new position using metal implants.
Minimally Invasive Treatment of Pectus Carinatum
A minimally invasive alternative is the MIPCR (Minimally Invasive Pectus Carinatum Repair) procedure. In the MIPCR procedure, the surgeon makes a longitudinal incision on each side of the chest.
They then attach stabilizers to the ribs and insert a bar. The bar and stabilizers help correct the curvature. However, not every case of pectus carinatum is suitable for MIPCR. You should discuss with a pectus carinatum specialist whether you are a candidate for a minimally invasive procedure.
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