Overview of Chest Wall Deformities Treatment India

A chest wall deformity or pectus excavatum is a structural abnormality of the chest that can be mild or severe. It occurs when the cartilage that connects the ribs grows unevenly. This condition is genetic and run in families.

Also known as abnormal development of the chest, it is congenital and is common at birth or in childhood. These deformities are visible in the early stage, when a child is 1 or 2 years old. This malformation increases rapidly during puberty, when the childs cartilage and bones are growing. There are several types of anomalies, and some common are Pectus excavatum or pectus carinatum. The less common types of abnormal developments are Jeune syndrome, pectus carinatum, and defects of the ribs and sternum.

This condition may or may not have any symptoms at all. Some children have problems breathing and have a risk of asthma and respiratory infections. The children with any type of chest wall deformity are prone to develop scoliosis. Depending on the severity and type of deformity, it is treated with a brace, a surgery or no treatment at all.

Doctors wait to perform surgery until the child reaches adolescence and the child's growth has happened. Surgery is usually recommended for children of 4 years, an age when bones are soft and easy to reposition.

Types of Chest Wall Deformities Treatment India

Types of Chest Wall Deformity

01. Pectus Excavatum - Also known as sunken or funnel chest, it occurs when the breastbone is pushed inward, and the lower half of the sternum is affected. It is the most common type of chest wall deformity and affects 1 out of every 300 to 400 children. It is three times more common in boys than girls. It causes lung capacity restriction and cardiac compression. Patients may also experience chest pain, shortness of breath and asthma.

02. Pectus Carinatum - Also known as raised chest or pigeon chest, it is a condition where ribs and breastbone jut. In some children, both sides of the chest protrude and in some children, one side of the chest sticks out to the other side. It affects about 1 in every 1,500 children. Boys are prone to this condition as compared to girls.

03. Jeune Syndrome - In this condition, the ribs are broad, abnormal, short and join to costal cartilages abnormally. Due to this, an inflexible chest cavity is small-bell shaped, and makes it difficult to breathe. The symptoms begin in a newborn for up to 4 to 5 years of age. The most severe conditions can cause breathing difficulty and the child needs a mechanical ventilator.

04. Poland Syndrome - It consists of several chest wall abnormalities of one chest side. These include rib abnormalities, pectoralis muscle, under development of areola and breast tissue, inadequate development of the hand, arm and fingers. In this condition, the right side of the body is affected more as compared to the left side. The mild signs of this condition often go undiagnosed.

Pectus Excavatum Treatments

01. Bracing - In most cases, treatment may not be required. The most common approach is using brace. Patients need to wear braces for 8 hours a day for 6 months. It is a semi-padded brace that corrects the outward presence of the chest with consistent pressure. This pressure causes cartilage to reshape itself. Doctor will analyze the amount of required pressure to resolve it. The results are visible within the first few months.

02. Surgery - There are two types of surgeries to treat chest wall deformities and Ravitch (open) procedure and Nuss (minimally invasive) procedure.

2.1. Ravitch Procedure - In this procedure, the surgeon removes abnormal cartilage and ribs by making a large incision in the chest. The space in the chest will be filled with a support system which is removed in 6 to 12 months. As the ribs and sternum heal, the ribs and chest stay in normal position. It is advice for patients of 14 to 21 years old.

2.2. The Nuss Procedure - It is an advanced and less invasive technique. Surgeons will make small incisions and insert a curved metal bar to remove sternum and ribs. A stabilizer bar is inserted in the chest and this will help reshape the chest in 3 years. After reshaping is done, the bar will be removed surgically. It is used on patients aged 8 and older.

Diagnosis of Chest Wall Deformities Treatment India

Symptoms of Pectus Excavatum

For most people, the common sign is a slight dent in the chest. This depth of the dent worsens in childhood and continues to worsen till adulthood. The common signs may include:

01. Chest pain

02. Recurrent respiratory infections

03. Fatigue

04. Murmur sound in heart

05. Reduced exercise tolerance

06. Heart palpitations

07. Coughing

08. Dizziness

Diagnosis of Pectus Excavatum

Pectus excavatum is diagnosed by examining the chest. However, doctors may suggest several other tests to check for problems with the lungs and heart. These tests may include:

01. CT Scan - It is used to analyze the severity of the disease and whether heart or lungs are compressed or not. In this test, many X-rays are taken from a variety of angles to get cross-sectional images of internal body structure. Doctors may ask to undergo tests to look at the effects of the compression on the heart while breathing in and out.

02. Chest X-ray - It used to check the dip in the breastbone and shows the position of the heart as well. It takes only a few minutes to complete this.

03. Electrocardiogram - It shows whether the hearts rhythm is normal or not, and timing of electrical signals that control the heartbeat. It is painless and involves placement of electrical leads that are attached to the body with adhesive.

04. Echocardiogram - It is a sonogram of the heart that shows real-time images of how the heart and valve are working. The transmitting sound waves are used to produce images against the chest. This test gives your doctor a view on how the chest wall is affecting heart functions and blood flow.

05. Lung Function Tests - This test measures the amount of air that your lungs can hold and time it takes to empty your lungs.

06. Exercise Test - It is used to monitor the functionality of the heart and lungs while you exercise, especially on the treadmill.

Symptoms and Risk factors

The signs and symptoms of chest wall deformities do vary with diagnosis and age, but the most prominent sign includes difficulty breathing. Consult the doctor, if you are experiencing issues with breathing.

Top Hospitals for Chest Wall Deformities in India

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Manipal Hospital, Jaipur Jaipur,India

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Top Doctors for Chest Wall Deformities in India

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Dr. Ankit Bhatia

Department of Pulmonology

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Dr (Col) S.P Rai

Department of Pulmonology

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Dr. A S Sandhya

Department of Pulmonology

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Dr. Azmat Karim

Department of Pulmonology

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Dr. Fadime Keleşoğlu

Department of Cardiology

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Chest Wall Deformities - Frequently Asked Questions

There are several types of chest wall deformities, namely Pectus excavatum, Pectus carinatum, Jeune Syndrome and Poland Syndrome. Pectus excavatum is the most common type of chest deformity.

It is a congenital deformity of the chest in which the chest wall grows in an inward direction.

In some cases, pectus excavatum can interfere with the functionality of lungs and heart. However, even mild cases of this condition can make children feel self-conscious about their appearance.

Bracing is the first choice as treatment to fix the chest wall deformities. A lightweight padded brace is wrapped around the chest for some hours for at least six months. This brace pushes the chest bone in a normal position.

There is no such evidence that can prove the life expectancy due to this condition. However, individuals can develop more symptoms over time

No, exercise is not effective in fixing pectus excavatum. However, physical deformity cannot be treated with exercise but it can help to improve posture and degree of chest.