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Causes and Types

Causes and Types

 

Funnel chest and pigeon chest are caused by hereditary factors, weakness of the costal cartilage (defective metabolism in the cartilage), and mechanical forces.

Abnormal posture in adolescence has an adverse effect on the equilibrium of the chest wall. In many cases the deformity worsens while the body is growing rapidly.

Even though the commonest deformities fall into recognised categories, each patient needs an individualised approach to diagnosis and treatment. 

Surgical and non-surgical treatments can complement one another in the course of treatment, rather than being seen as alternatives.  Each treatment has its optimal time window and bone maturation needs to be taken into account.

The majority of patients are men, but these deformities affect both men and women. Sometimes the soft tissues covering the ribcage are affected. Supplementary plastic surgery (such as implants) is needed in some cases, particularly in female patients.

Minimally invasive or minimal-access surgery is used, with the approach tailored to the individual patient. All procedures are subject to standardised aftercare and quality control.

 

Symmetrical Funnel Chest (Pectus Excavatum)

Even when funnel chest seems symmetrical, on closer examination it is often deeper on one side, usually on the right. For this reason we always carry out magnetic resonance imaging of the chest (avoiding ionising radiation), an electrocardiogram (ECG) and echocardiography in order to plan the operation in detail.

 

Asymmetrical Funnel Chest

Here the deepest point of the indrawn chest lies away from the mid-line, usually in the region of the costal cartilage which joins the ribs to the breastbone. 

Asymmetry of the anterior chest wall is often associated with deformities of the thoracic spine. These should be investigated as early as possible by an orthopaedic specialist, so that specific exercises or orthotic treatment can be offered to correct them.

This asymmetry can displace the organs of the chest, particularly the heart and the great blood vessels.

 

Pigeon Chest (Pectus Carinatum)

In pigeon chest there is protrusion of the breastbone and/or neighbouring ribs. The chest wall is indrawn at the sides and often asymmetrical. This can reduce the volume of the chest, restrict inflation of the lungs and place abnormal loads on the spine.

Symptoms are less common than in funnel chest, as the functioning and position of the heart are usually unaffected.

 

 

Special forms

→ Combined deformity
→ Pectus arcuatum
→ Poland Syndrome
→ Amazon Syndrome
→ Complex chest wall deformity

 

 

Combined deformity

A combination of asymmetrical funnel chest and pigeon chest. Here the cause is an axial torsion of the breastbone with protrusion or depression of the adjacent rib cartilage.

 

Pectus arcuatum

This involves a shortening of the breastbone and protrusion of its upper aspect. The rib cartilages are elongated and drawn upward. Open surgery is necessary to correct this deformity.

 

Poland Syndrome

This involves defects in the ribs and in the soft tissues (pectoral muscles, breasts) and abnormalities of hair growth, often combined with malformations of the hand and arm.

Correction is difficult and has to be undertaken in several stages. As well as the bony reconstruction, a complex soft tissue reconstruction is needed, and this should only be undertaken by experienced plastic surgeons.

 

Amazon Syndrome

Named after the women archers of Greek mythology, this consists of a funnel chest, usually on the right, combined with stunted development of the muscles and breast on the affected side.

In this situation the surgery for correction of the funnel chest and subsequent breast reconstruction should be planned in conjunction with experienced plastic surgeons.

 

 

Complex chest wall deformities

This category includes clefts in the breastbone (sternoschisis) leading to forward displacement of the heart (ectopia cordis). It also includes so-called syndromes (such as the pentalogy of Cantrell) with more widespread defects and includes ‘secondary’ deformities of the chest wall in severe spinal deformity (kyphoscoliosis). In this latter case, the spinal column must usually be stabilised before chest wall surgery can be undertaken.

These unusual forms call for an individualised approach and require a highly experienced surgical team.

 

Pentalogy of Cantrell

A combination of abdominal wall, chest wall and diaphragmatic defects with congenital heart disease.

 

Clefts in the Breastbone (Sternoschisis)

The breastbone (sternum) can from birth be partially or completely divided into two halves.

 

Marfan Syndrome

Funnel chest can occur in the context of this hereditary connective tissue disorder. Other signs include hypermobility of joints, spider fingers (arachnodactyly), abnormal teeth, and anomalies of the heart, blood vessels and eyes.

 

Protrusion of the Ribcage

Protruding ribs are often seen in combination with funnel chest, but can occur on their own.

These protrusions can increase the visual impact of a funnel chest. Correction of the rib deformity should be considered in the treatment plan and can either be combined with the funnel chest operation or be carried out as a separate procedure.