Pectus carinatum

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Pectus carinatum_table_infobox_0

Pectus carinatumPectus carinatum_header_cell_0_0_0
Other namesPectus carinatum_header_cell_0_1_0 Pigeon chest, pectus cavernatum, bird chest, convex chestPectus carinatum_cell_0_1_1
SpecialtyPectus carinatum_header_cell_0_2_0 OrthopedicsPectus carinatum_cell_0_2_1

Pectus carinatum, also called pigeon chest, is a malformation of the chest characterized by a protrusion of the sternum and ribs. Pectus carinatum_sentence_0

It is distinct from the related malformation pectus excavatum. Pectus carinatum_sentence_1

Signs and symptoms Pectus carinatum_section_0

Causes Pectus carinatum_section_1

Diagnosis Pectus carinatum_section_2

The pectus carinatum can be easily diagnosed by certain tests like a CT scan (2D and 3D). Pectus carinatum_sentence_2

It may then be found out that the rib cage is in normal structure. Pectus carinatum_sentence_3

If there is more than average growth of sternum than pectus carinatum protrudes. Pectus carinatum_sentence_4

Also it is of two types, as pectus carinatum is symmetrical or unsymmetrical. Pectus carinatum_sentence_5

On the basis of that further treatment is given to the patient. Pectus carinatum_sentence_6

Treatment Pectus carinatum_section_3

External bracing technique Pectus carinatum_section_4

The use of orthotic bracing, pioneered by Sydney Haje as of 1977, is finding increasing acceptance as an alternative to surgery in select cases of pectus carinatum. Pectus carinatum_sentence_7

In children, teenagers, and young adults who have pectus carinatum and are motivated to avoid surgery, the use of a customized chest-wall brace that applies direct pressure on the protruding area of the chest produces excellent outcomes. Pectus carinatum_sentence_8

Willingness to wear the brace as required is essential for the success of this treatment approach. Pectus carinatum_sentence_9

The brace works in much the same way as orthodontics (braces that correct the alignment of teeth). Pectus carinatum_sentence_10

The brace consists of front and back compression plates that are anchored to aluminum bars. Pectus carinatum_sentence_11

These bars are bound together by a tightening mechanism which varies from brace to brace. Pectus carinatum_sentence_12

This device is easily hidden under clothing and must be worn from 14 to 24 hours a day. Pectus carinatum_sentence_13

The wearing time varies with each brace manufacturer and the managing physicians protocol, which could be based on the severity of the carinatum malformation (mild moderate severe) and if it is symmetric or asymmetric. Pectus carinatum_sentence_14

Depending on the manufacturer and/or the patient's preference, the brace may be worn on the skin or it may be worn over a body 'sock' or sleeve called a Bracemate, specifically designed to be worn under braces. Pectus carinatum_sentence_15

A physician or orthotist or brace manufacturer's representative can show how to check to see if the brace is in correct position on the chest. Pectus carinatum_sentence_16

Bracing is becoming more popular over surgery for pectus carinatum, mostly because it eliminates the risks that accompany surgery. Pectus carinatum_sentence_17

The prescribing of bracing as a treatment for pectus carinatum has 'trickled down' from both paediatric and thoracic surgeons to the family physician and pediatricians again due to its lower risks and well-documented very high success results. Pectus carinatum_sentence_18

The pectus carinatum guideline of 2012 of the American Pediatric Surgical Association has stated: "As reconstructive therapy for the compliant pectus [carinatum] malformation, nonoperative compressive orthotic bracing is usually an appropriate first line of therapy as it does not preclude the operative option. Pectus carinatum_sentence_19

For appropriate candidates, orthotic bracing of chest wall malformations can reasonably be expected to prevent worsening of the malformation and often results in a lasting correction of the malformation. Pectus carinatum_sentence_20

Orthotic bracing is often successful in prepubertal children whose chest wall is compliant. Pectus carinatum_sentence_21

Expert opinion suggests that the noncompliant chest wall malformation or significant asymmetry of the pectus carinatum malformation caused by a concomitant excavatum-type malformation may not respond to orthotic bracing." Pectus carinatum_sentence_22

Regular supervision during the bracing period is required for optimal results. Pectus carinatum_sentence_23

Adjustments may be needed to the brace as the child grows and the pectus improves. Pectus carinatum_sentence_24

Surgical Pectus carinatum_section_5

For patients with severe pectus carinatum, surgery may be necessary. Pectus carinatum_sentence_25

However bracing could and may still be the first line of treatment. Pectus carinatum_sentence_26

Some severe cases treated with bracing may result in just enough improvement that patient is happy with the outcome and may not want surgery afterwards. Pectus carinatum_sentence_27

If bracing should fail for whatever reason then surgery would be the next step. Pectus carinatum_sentence_28

The two most common procedures are the Ravitch technique and the Reverse Nuss procedure. Pectus carinatum_sentence_29

A modified Ravitch technique uses bioabsorbable material and postoperative bracing, and in some cases a diced rib cartilage graft technique. Pectus carinatum_sentence_30

The Nuss was developed by Donald Nuss at the Children's Hospital of the King's Daughters in Norfolk, Va. Pectus carinatum_sentence_31

The Nuss is primarily used for Pectus Excavatum, but has recently been revised for use in some cases of PC, primarily when the malformation is symmetrical. Pectus carinatum_sentence_32

Other options Pectus carinatum_section_6

After adolescence, some men and women use bodybuilding as a means to hide their malformation. Pectus carinatum_sentence_33

Some women find that their breasts, if large enough, serve the same purpose. Pectus carinatum_sentence_34

Some plastic surgeons perform breast augmentation to disguise mild to moderate cases in women. Pectus carinatum_sentence_35

Bodybuilding is suggested for people with symmetrical pectus carinatum. Pectus carinatum_sentence_36

Prognosis Pectus carinatum_section_7

Pectus malformations usually become more severe during adolescent growth years and may worsen throughout adult life. Pectus carinatum_sentence_37

The secondary effects, such as scoliosis and cardiovascular and pulmonary conditions, may worsen with advancing age. Pectus carinatum_sentence_38

Body building exercises (often attempted to cover the defect with pectoral muscles) will not alter the ribs and cartilage of the chest wall, and are generally considered not harmful. Pectus carinatum_sentence_39

Most insurance companies no longer consider chest wall malformations like pectus carinatum to be purely cosmetic conditions. Pectus carinatum_sentence_40

While the psychologic impact of any malformation is real and must be addressed, the physiological concerns must take precedence. Pectus carinatum_sentence_41

The possibility of lifelong cardiopulmonary difficulties is serious enough to warrant a visit to a thoracic surgeon. Pectus carinatum_sentence_42

Epidemiology Pectus carinatum_section_8

Pectus malformations are common; about 1 in 400 people have a pectus disorder. Pectus carinatum_sentence_43

Pectus carinatum is rarer than pectus excavatum, another pectus disorder, occurring in only about 20% of people with pectus malformations. Pectus carinatum_sentence_44

About four out of five patients are males. Pectus carinatum_sentence_45

See also Pectus carinatum_section_9

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Credits to the contents of this page go to the authors of the corresponding Wikipedia page: en.wikipedia.org/wiki/Pectus carinatum.