Thoracic Abnormalities

Types of Thoracic Abnormalities

Pectus Excavatum

Pectus excavatum is a genetic condition that is often present at birth. In children with pectus excavatum, several ribs and the breastbone (sternum) grow abnormally and turn inward, forming a hollow in the center of the chest. The condition can be mild and barely noticeable or so severe that the heart and lungs are affected.

Pectus Carinatum

Pectus carinatum is a disorder that affects the cartilage of the rib bones and the sternum, resulting in an anterior protrusion of the chest. The connective tissue becomes too stretchy, pushing the bones outward. The heart and lungs develop normally. Pectus carinatum is not always present at birth and can develop and worsen as a child gets older, especially during growth spurts. The condition is more common in boys than in girls.

Pectus carinatum may occur alone or along with other conditions, including:

Trisomy 18
Down Syndrome (trisomy 21)
Marfan syndrome (a type of connective tissue disorder)

Congenital Pulmonary Airway Malformations (CPAM)

Congenital pulmonary airway malformation (CPAM) is a type of congenital pulmonary anomaly. CPAM involves an abnormal piece of lung tissue that appears as a mass distinct from the normal lung on imaging tests.

What are the symptoms of thoracic abnormalities?

Symptoms of thoracic abnormalities can range from asymptomatic to pain and breathing complications.

Symptoms of pectus excavatum and pectus carinatum include:

Shortness of breath during exercise
Chest pain
Psychological impact to self-image and self-confidence
Impaired heart and lung function

Symptoms of CPAM include:

Breathing trouble or respiratory distress
Rapid breathing
Heart and lung compression

A multidisciplinary team of pediatric surgeons, obstetricians, maternal fetal medicine, neonatologists and pulmonologists monitors developing babies and children with thoracic abnormalities. Ultrasound and fetal magnetic resonance imaging (MRI) scans are used to track development of CPAM and check heart and lung formation.

In most cases, treatment is not needed before birth. Many children with CPAM will need treatment during the first year of life, while other children can lead normal lives without surgery. Children with pectus excavatum or pectus carinatum may need treatment to improve breathing or appearance. The Riley at IU Health Chest Wall Program providers reconstructive care to children with this type of thoracic abnormality.

Diagnosis of Thoracic Abnormalities

Doctors at Riley at IU Health perform the following exams and tests to diagnose thoracic abnormalities:

Clinical exam. Your child’s doctor or a pediatric surgeon will examine your child’s body, looking for signs of pectus excavatum or pectus carinatum.
Computed tomography (CT). A CT scan of the chest makes cross-sectional pictures of the lungs, ribs and sternum to view lesions on the lung tissue (CPAM) or uncover the extent of pectus excavatum or pectus carinatum.
X-ray. X-ray may be used to create images of the ribs, sternum and lungs.
Magnetic resonance imaging (MRI). MRI uses a magnetic field and radio waves to create detailed images of internal body tissues such as the lungs, heart and blood vessels.

Treatment Options for Thoracic Abnormalities

The most common treatment for thoracic abnormalities is regular monitoring by a pediatric surgeon to track the size of any existing congenital pulmonary airway malformations or the extent of pectus excavatum or pectus carinatum. Other treatments include:

Surgery. A pediatric surgeon will discuss the best procedure for your child based on his or her specific condition. Different surgical approaches are available. They include:
- Pectus excavatum surgery. When children with a severe sunken chest experience frequent symptoms, a pediatric surgeon can perform procedures to expand the chest and allow the lungs to better expand.
- Pectus carinatum surgery. Though most cases of pectus carinatum can be successfully managed with bracing, a surgical procedure is available to correct the protrusion or pushed-out appearance in severe cases. The procedure moves the breastbone back into a more normal position.
- Congenital pulmonary airway malformation surgery. Children who require surgery for lung lesions or cysts often receive it within the first year of life. Others get the procedure later when symptoms develop. A pediatric surgeon can remove the lump or lesion in lung tissue to help restore function.
Chest brace (for pectus carinatum). Most children with a protruding chest can wear a brace that pushes the sternum back in. The brace is worn most of the day. It puts pressure on the anterior chest wall, moving the sternum and ribs back into a more normal position.
Psychological counseling. Children with a sunken or protruding chest may feel self-conscious about their appearance, develop low self-esteem or feel depressed or anxious. A psychologist, psychiatrist or social worker can talk with your child about his or her feelings and provide guidance for improved well-being.

Key Points to Remember

Thoracic abnormalities include two different kinds of conditions: chest wall deformities and problems in the development of lung tissue.
These conditions are often asymptomatic, but they can cause pain, trouble breathing and shortness of breath during exercise.
The most common treatment for these conditions is regular monitoring.
Additional treatment options include bracing, psychological counseling and surgery.

Support Services & Resources

Visit the links below to learn more about thoracic abnormalities and find support groups.

Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.

Learn More About Riley Support Services

MedlinePlus

Read more about pectus excavatum on this U.S. National Library of Medicine website.

MedlinePlus

This site also provides more information about pectus carinatum.