|Other names||Pigeon chest, pectus cavernatum, bird chest, convex chest|
It is distinct from the related malformation pectus excavatum.
Signs and symptoms
The pectus carinatum can be easily diagnosed by certain tests like a CT scan (2D and 3D).
It may then be found out that the rib cage is in normal structure.
If there is more than average growth of sternum than pectus carinatum protrudes.
Also it is of two types, as pectus carinatum is symmetrical or unsymmetrical.
On the basis of that further treatment is given to the patient.
External bracing technique
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.
Willingness to wear the brace as required is essential for the success of this treatment approach.
The brace works in much the same way as orthodontics (braces that correct the alignment of teeth).
The brace consists of front and back compression plates that are anchored to aluminum bars.
These bars are bound together by a tightening mechanism which varies from brace to brace.
This device is easily hidden under clothing and must be worn from 14 to 24 hours a day.
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.
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.
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.
Bracing is becoming more popular over surgery for pectus carinatum, mostly because it eliminates the risks that accompany surgery.
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.
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.
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.
Orthotic bracing is often successful in prepubertal children whose chest wall is compliant.
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."
Regular supervision during the bracing period is required for optimal results.
Adjustments may be needed to the brace as the child grows and the pectus improves.
For patients with severe pectus carinatum, surgery may be necessary.
However bracing could and may still be the first line of treatment.
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.
If bracing should fail for whatever reason then surgery would be the next step.
The two most common procedures are the Ravitch technique and the Reverse Nuss procedure.
A modified Ravitch technique uses bioabsorbable material and postoperative bracing, and in some cases a diced rib cartilage graft technique.
The Nuss was developed by Donald Nuss at the Children's Hospital of the King's Daughters in Norfolk, Va.
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.
After adolescence, some men and women use bodybuilding as a means to hide their malformation.
Some women find that their breasts, if large enough, serve the same purpose.
Some plastic surgeons perform breast augmentation to disguise mild to moderate cases in women.
Bodybuilding is suggested for people with symmetrical pectus carinatum.
Pectus malformations usually become more severe during adolescent growth years and may worsen throughout adult life.
The secondary effects, such as scoliosis and cardiovascular and pulmonary conditions, may worsen with advancing age.
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.
Most insurance companies no longer consider chest wall malformations like pectus carinatum to be purely cosmetic conditions.
While the psychologic impact of any malformation is real and must be addressed, the physiological concerns must take precedence.
The possibility of lifelong cardiopulmonary difficulties is serious enough to warrant a visit to a thoracic surgeon.
Pectus malformations are common; about 1 in 400 people have a pectus disorder.
Pectus carinatum is rarer than pectus excavatum, another pectus disorder, occurring in only about 20% of people with pectus malformations.
About four out of five patients are males.
Credits to the contents of this page go to the authors of the corresponding Wikipedia page: en.wikipedia.org/wiki/Pectus carinatum.