excavatum

Pectus excavatum, commonly known simply as excavatum, is the most frequent congenital deformity of the anterior chest wall, characterized by a sunken sternum and adjacent cartilages. The inward growth or overgrowth of costal cartilages causes the sternum to dip posteriorly, which can be mild or more pronounced. The condition may be isolated or associated with connective tissue disorders such as Marfan syndrome or Ehlers-Danlos syndrome, and it can run in families.

Clinical features range from cosmetic concern to physiological impairment. Some individuals notice reduced exercise tolerance, chest pain, shortness of breath, or palpitations, particularly during exertion. In severe cases, the inward chest wall can compress the heart and lungs, contributing to cardiopulmonary symptoms. Severity is often assessed by imaging studies and physical examination.

Diagnosis involves a clinical assessment supported by imaging. Lateral chest X-ray, CT, or MRI can measure the Haller index, the ratio of the chest’s width to the depth of the depression; a higher index indicates greater severity and can guide treatment decisions. Echocardiography or pulmonary function tests may be used to evaluate cardiac or lung involvement.

Management ranges from observation to intervention. Mild or asymptomatic cases may only require routine monitoring and exercise. Non-surgical options include physical therapy and, in select cases, a vacuum bell device to gradually elevate the sternum. Surgical correction is considered for symptomatic or structurally severe deformities. The two main procedures are the Nuss procedure, a minimally invasive technique using a curved metal bar to elevate the sternum, and the Ravitch procedure, which involves resection of cartilages and sternal osteotomy with temporary support.

Postoperative recovery varies, with potential risks including bar-related complications, infection, and pneumothorax. Overall prognosis after correction is favorable, with improvements in appearance and, in many cases, cardiopulmonary function. See also pectus carinatum.