Pectus excavatum is the most common chest wall deformity: the breastbone and lower ribs sink inward and form a hollow in the chest. It often becomes more obvious during the teenage growth spurt and can affect self-image and, when severe, heart and lung function.
Key symptoms
- Visible hollow in the front of the chest
- Shortness of breath or tiring quickly with exercise
- Chest pain or palpitations in some patients
- Embarrassment about appearance, avoiding sports or swimming
What you find on exam
- Depth and shape of the chest depression, symmetric or not
- Heart sounds and murmurs; the heart may be shifted to the left
- Signs of Marfan syndrome: tall build, long limbs, flexible joints
- Posture and a scoliosis check
Tests
- Chest CT or MRI to measure the Haller index (over 3.25 suggests a severe defect)
- Echocardiogram for heart compression or mitral valve prolapse
- Pulmonary function tests and exercise testing
- ECG if palpitations or chest pain
Treatment basics
- Mild cases: reassurance, posture and breathing exercises
- Vacuum bell device in selected younger patients
- Minimally invasive repair with a metal bar (Nuss procedure) for severe cases
- Referral to cardiology or genetics when a connective tissue disease is suspected
Red flags
- Fainting or chest pain during exercise
- New murmur or features of Marfan syndrome
- Worsening breathlessness that limits daily activity
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.