Pectus Carinatum: Confident Chest Care

Pectus Carinatum (Pigeon Chest): Causes, Symptoms, and Treatment

Pectus carinatum, commonly called pigeon chest, is a chest wall deformity where the breastbone (sternum) and ribs protrude outward. This causes the chest to appear bulging or bird-like, resembling a pigeon's chest.

What Is Pectus Carinatum?

Pectus carinatum is a structural abnormality in which the sternum and rib cartilage grow excessively, causing the chest to protrude outward. It is most often noticed during childhood or adolescence, especially during periods of rapid growth. The condition may be present at birth (congenital) or develop later as a result of another underlying issue. While pectus carinatum usually does not cause pain, it can lead to physical discomfort, cosmetic concerns, and psychological distress. Treatment typically involves orthopedic bracing or surgical correction to improve the shape and function of the chest.

Types of Pectus Carinatum

There are several types of pectus carinatum, classified according to the symmetry and structural features of the chest wall:

• Chondrogladiolar Type (most common, ~89%):  Characterized by the outward protrusion of the lower sternum and costal cartilage, this type is typically symmetrical.
• Chondromanubrial Type: Affects the upper sternum (manubrium) and the second and third rib cartilages; may present with a slight depression in the mid-sternum.
• Mixed Type: A mixed type involves both pectus carinatum and pectus excavatum, where one side of the chest protrudes outward while the opposite side appears sunken.
• Symmetrical: Both sides of the chest protrude evenly.
• Asymmetrical: One side of the chest wall protrudes more than the other.

How Common Is Pigeon Chest?

Pectus carinatum is the second most common chest wall deformity after pectus excavatum. It is estimated to occur in approximately 1 in 1,000 to 1 in 2,500 live births. The condition is three to five times more common in males than in females.

Causes and Risk Factors

While the exact cause of pectus carinatum is not fully understood, genetic predisposition plays a significant role. It is often seen in individuals with a family history of chest wall abnormalities and may develop during periods of rapid growth. In some cases, it is associated with connective tissue disorders such as:

• Marfan Syndrome
• Ehlers-Danlos Syndrome
• Noonan Syndrome
• Morquio Syndrome

Other risk factors include:

• Congenital heart disease
• Scoliosis
• Vitamin D deficiency (rickets)
• Male gender
• Rapid puberty growth spurts

Key Symptoms of Pectus Carinatum

The most noticeable sign of pectus carinatum is a protruding sternum. This protrusion can range from mild to severe and may be either symmetrical or asymmetrical.

While often painless, it can lead to:

• Chest tenderness or mild discomfort
• Shortness of breath during exercise
• Fatigue and reduced stamina

Postural issues

• Low self-esteem or social anxiety, especially among teenagers

Physical Appearance

• Outward bulging of the chest wall
• Flat or concave appearance on the side opposite the chest protrusion, seen in mixed-type cases.
• Asymmetrical or symmetrical chest shape
• In some cases, accompanying spinal curvature or shape irregularities

Health Effects

• Although pectus carinatum is generally viewed as a cosmetic concern, in rare cases it may reduce respiratory efficiency or cause mild chest pain, particularly during vigorous physical activity.

When to See a Doctor?

Consult a healthcare provider if:

• A new or increasing chest protrusion is observed
• You or your child experiences shortness of breath, fatigue, or chest pain
• There are psychological effects such as low confidence or social withdrawal
• There is a family history of chest wall deformities

A pediatrician or thoracic surgeon will typically conduct a physical exam and may request imaging tests (X-ray or CT scan) to assess the severity. Treatment decisions will depend on individual anatomy, age, and symptom intensity.

Early detection of pectus carinatum improves treatment outcomes. Bracing therapy is most effective in growing children, while minimally invasive surgery may be considered in severe or unresponsive cases. Addressing both physical and emotional effects is crucial for long-term well-being.

How Is Pigeon Chest (Pectus Carinatum) Diagnosed?

The diagnosis of pigeon chest (pectus carinatum) is usually made easily through a physical examination. However, imaging techniques may also be used to assess the severity of the deformity and identify any accompanying conditions. The doctor observes and evaluates the forward protrusion of the chest wall. To confirm the diagnosis and determine the degree of the deformity, imaging tests such as chest X-rays, computed tomography (CT), or magnetic resonance imaging (MRI) may be used to examine abnormalities in the chest structure in detail.

Additionally, echocardiography and pulmonary function tests may be conducted to assess heart and lung function. These evaluations help confirm the diagnosis and guide the most appropriate treatment options.

Physical Examination Findings

A physical examination is the first and most important step in diagnosing pectus carinatum. During this exam, the doctor carefully observes and palpates the patient to assess the following aspects:

• Appearance of the Chest Wall:The most prominent finding is the forward protrusion of the sternum and/or costal cartilages (the cartilage connecting the ribs to the sternum). The doctor evaluates the shape, size, symmetry, and location of the protrusion during the examination.
• Localization of the Protrusion: It is determined which part of the sternum (upper, middle, or lower) or which rib cartilages the protrusion is concentrated in (chondrogladiolar, chondromanubrial type).
• Flexibility of the Chest Wall: The doctor may gently press on the chest wall to assess its flexibility. In some cases, the chest wall may feel stiffer than normal.
• Presence of Other Deformities: The doctor checks for the presence of scoliosis (curvature of the spine) or other chest wall abnormalities, such as pectus excavatum.
• Heart and Lung Examination: The doctor listens to heart sounds and examines the lungs to assess any possible cardiovascular or respiratory issues.

Imaging Techniques (X-ray, CT)

After the physical examination, imaging methods may be used to confirm the diagnosis and assess the extent of the deformity.

Chest X-ray

Frontal and lateral chest X-rays show the overall structure of the chest wall, the position of the sternum, and highlight the presence of any protrusion. They also provide general information about the condition of the lungs and heart. X-rays are useful for roughly assessing the type and severity of pectus carinatum.

Computed Tomography (CT)

CT scanning produces highly detailed images of the bones and cartilage of the chest wall. It accurately reveals the exact shape and severity of the deformity, shows the relationship between the sternum and ribs, and identifies any pressure on internal organs. CT is often preferred prior to treatment planning, particularly before surgical intervention. Additionally, CT can provide measurements such as the Haller index, which is more commonly used in cases of pectus excavatum.

Additional Tests (Pulmonary Function Tests, ECG)

Although pectus carinatum typically does not cause respiratory or cardiac problems, further tests may be performed in certain cases:

• Pulmonary Function Tests (PFTs): Pulmonary function tests are used to assess lung capacity and airflow in patients who experience shortness of breath or have limited exercise tolerance. These tests help determine whether pectus carinatum has any effect on lung function. In most cases, there is no significant restriction, but mild restrictive patterns may be identified in some individuals.
• Electrocardiography (ECG): An electrocardiogram (ECG) is a simple, painless test used to assess heart function. Although pectus carinatum itself typically does not directly impact the heart, an ECG may be performed to evaluate any related cardiovascular symptoms or concerns that arise alongside the condition.

The need for these tests depends on the patient's symptoms, findings from the physical examination, and the doctor's clinical judgment. In most cases, a physical exam and chest X-ray are sufficient for making a diagnosis.

Treatment Options for Pigeon Chest (Pectus Carinatum)

Treatment for pigeon chest varies based on the severity of the deformity, the patient's age, and the presence of symptoms. In mild and flexible cases, especially in growing children, the use of a custom-designed orthopedic brace (bracing) can be very effective. These braces apply external pressure to the sternum and help gradually correct the deformity over time.

In more advanced cases or when bracing fails to provide results, surgical intervention may be considered.

Treatment Methods for Pectus Carinatum

Treatment options for pectus carinatum include both surgical and non-surgical approaches. Among surgical methods, the most common is the Ravitch procedure, which involves reshaping the protruding sternum. In addition to these interventions, breathing exercises, physical therapy, and psychological support may be necessary. With early diagnosis and appropriate treatment, positive outcomes can be achieved both aesthetically and functionally.

How Is the Treatment Decision Made?

The decision-making process in treating pectus carinatum involves carefully evaluating several key factors:

• Age: Treatment options and their success rates depend on the patient's age. Bracing is most effective for children and adolescents whose bones and cartilage are more flexible during periods of growth. Bracing tends to be less successful in adults. Surgical treatment, however, can be performed at any age, although recovery times may differ depending on the person's age.
• Severity of the Deformity: The severity of the deformity is a key factor in determining the appropriate treatment. Mild cases may not require intervention or may respond well to conservative approaches such as bracing. In contrast, severe cases are more likely to benefit from surgical treatment. The extent of the deformity is typically evaluated through physical examination and imaging, particularly CT scans.
• Symptoms: Symptoms such as shortness of breath, chest pain, or fatigue can affect the choice of treatment. If significant psychological distress occurs due to appearance, treatment should be considered. When concerns are purely cosmetic, the decision may depend on the patient's preferences and the severity of the deformity.

These factors are evaluated together to create the most appropriate treatment plan, involving the patient and their family in the decision-making process.

Non-Surgical Treatment (Brace Therapy)

As part of pectus carinatum treatment, brace therapy is offered as a non-surgical alternative. These custom-designed braces apply gentle, consistent pressure to the chest wall, gradually correcting the protrusion. Physicians often recommend brace therapy as the first non-surgical approach before considering surgical options.

Who Is Suitable for Brace Therapy?

Brace therapy may be considered in the following cases:

• Children and adolescents during growth periods: Because children and adolescents have more flexible bone and cartilage structures, they are more likely to respond well to brace therapy.
• Mild to moderate chondrogladiolar type pectus carinatum: This type responds best to brace treatment.
• Patients unwilling or unfit for surgery:For individuals with underlying health conditions or those wishing to avoid the risks associated with surgery, bracing offers a safe and effective alternative.

Success Rate and Duration of Brace Therapy

The success of brace therapy depends on factors such as the type and severity of the deformity, the patient's age, consistent brace use, and treatment compliance. When started early and worn regularly, braces can achieve a success rate between 50% and 80%.

The duration of brace use can range from 6 months to 2 years. Initially, the brace may be worn up to 23 hours a day, and as the deformity improves, the wearing time is gradually reduced. Consistent and correct use of the brace is essential for the success of the treatment.

Surgical Treatment: Pigeon Chest Surgery

Surgical treatment may be considered for severe cases of pectus carinatum, for patients in whom bracing has not been successful, or for adults. The aim of pigeon chest surgery is to correct the outward protrusion of the chest wall.

Pectus Carinatum Surgery Techniques

The primary surgical techniques used to correct pectus carinatum are:

Ravitch Technique and Its Modifications

In this technique, a horizontal incision is made on the anterior chest wall. The abnormally enlarged costal cartilages causing the protrusion are removed or reshaped. The sternum (breastbone) is repositioned correctly and usually temporarily stabilized using wires or plates. These wires or plates are often removed after a few months through a second minor surgery.

Modifications of the Ravitch technique aim to reduce incision size and improve cosmetic results.

Minimally Invasive Techniques

In recent years, minimally invasive surgical techniques have been developed that use smaller incisions. With the aid of a camera and specialized surgical instruments, surgeons can adjust the cartilage and correct the position of the sternum. These techniques generally result in:

• Less scarring
• Less pain
• Faster recovery

However, these procedures may not be suitable for every patient. The choice of surgical technique depends on the type and severity of the deformity, the patient's age, and the surgeon's experience.

Postoperative Recovery Process

The recovery process after pigeon chest surgery varies from patient to patient but generally includes the following stages:

• Hospital Stay: A hospital stay of 3 to 7 days is typically required after surgery. During this period, pain is managed, vital signs are closely monitored, and patients begin mobilizing under supervision.
• Pain Management: Postoperative pain is expected and can be effectively managed with prescribed pain medications..
• Movement Restrictions: Avoid heavy lifting and any movements that put strain on the chest for a certain period. Activity levels should be gradually increased according to your doctor's recommendations.
• Wound Care: Keeping the surgical area clean and dry reduces the risk of infection. Wound care should follow the doctor's instructions.
• Physical Therapy: After major surgery, physical therapy may be necessary to restore chest wall mobility and enhance lung function.
• Follow-Up Appointments: Regular doctor visits after surgery are essential to monitor your healing and identify any potential complications early.
• Full Recovery: Complete recovery typically takes anywhere from a few weeks to several months, during which time patients can gradually resume their normal activities.

Following the doctor's postoperative instructions and attending follow-up appointments are critical for successful recovery.

The Role of Exercise and Sports in Pigeon Chest Treatment

Activities such as swimming, yoga, pilates, and postural exercises target the muscles around the chest wall and can slow the progression of the deformity.

Regular exercise also supports brace therapy, enhances body awareness, and has positive psychological effects. However, any exercise program should be planned individually under the supervision of a doctor or physiotherapist.

Can Pigeon Chest Be Corrected with Exercise?

The answer to "Can pigeon chest be corrected with exercise? is that while exercise does not directly change bone structure, it can improve posture and muscle tone, resulting in a more aesthetically pleasing appearance.

In the context of treating pigeon chest, physical activity and exercise are particularly beneficial in mild cases. Strengthening the chest muscles, improving posture, and increasing lung capacity can help slow the progression of the deformity.

Regular physical activity further enhances the effectiveness of brace therapy, increases body awareness, and supports psychological well-being. However, all exercise programs should be individually tailored and supervised by healthcare professionals.

Is Exercise Alone Sufficient?

Exercise alone cannot directly correct pectus carinatum, as this condition involves structural abnormalities of the bones and cartilage. However, exercise can provide indirect benefits:

• Strengthening the chest and back muscles can improve chest wall appearance and posture, helping to make the protrusion less noticeable.
• Improving overall physical fitness: Regular exercise promotes better general health and can help boost self-confidence.

In summary, although exercise does not cure pectus carinatum, it can help improve physical appearance and overall well-being.

Supportive Exercises for Treatment

Certain exercises can support treatment and help improve the appearance of pectus carinatum:

1. Posture-Improving Exercises:

Shoulder Retractions: Sit or stand up straight. Pull your shoulders back and downward, squeezing your shoulder blades together. Hold this position for a few seconds, then relax.

• Wall Angels:Stand with your back against a wall and your feet slightly away from it. Raise your arms to shoulder height, bending your elbows. Slowly slide your arms up and down the wall, keeping your arms and elbows in contact with the wall throughout the movement.
• Cat-Cow Pose: While on all fours, alternate between arching your back upward into the "cat" position and lowering it downward into the "cow" position, coordinating each movement with your breath.

2. Chest Muscle Stretching Exercises:

• Doorway Chest Stretch: Stand in a doorway with your arms raised to shoulder height and elbows bent at 90 degrees, placing your hands on the doorframe. Step forward slowly until you feel a gentle stretch across your chest.
• Supine Arm Openings:Lie on your back with your knees bent. Extend your arms out to the sides at shoulder level. Slowly raise your arms overhead, feeling a gentle stretch across your chest.

3. Back Muscle Strengthening Exercises:

• Scapular Squeezes: Sit or stand with your arms at your sides. Squeeze your shoulder blades together, hold for a few seconds, and then release.
• Reverse Fly:Bend forward slightly at the hips while holding light weights in each hand. Keep your elbows slightly bent and lift your arms out to the sides until they are level with your shoulders. Lower your arms slowly and with control.

Pectus Carinatum and Associated Health Issues

While pectus carinatum is often an isolated condition, it can sometimes be associated with other health issues:

• Respiratory and Cardiovascular Symptoms: In rare cases, pectus carinatum may put pressure on the heart and lungs, which can lead to shortness of breath, fatigue during physical activity, or chest pain.
• Skeletal Disorders: Conditions such as scoliosis (curvature of the spine) and kyphosis (excessive outward curvature of the spine) can sometimes occur together.
• Connective Tissue Disorders: Genetic conditions such as Marfan syndrome and Ehlers-Danlos syndrome can be associated with pectus carinatum. Beyond physical symptoms, individuals”especially adolescents”may also experience psychological effects such as reduced self-esteem, depression, or social anxiety. Therefore, a multidisciplinary treatment approach is recommended.

Is Pectus Carinatum Harmful to Health?

In most cases, pectus carinatum is not harmful. However, some individuals may experience:

• Shortness of Breath: Particularly during intense physical activity, due to restricted lung expansion.
• Chest Pain: Mild discomfort or pain in the chest area, often musculoskeletal in origin.
• Fatigue: Increased tiredness during physical exertion, possibly related to respiratory inefficiency.

It's important to note that these symptoms are rare, and most people with pectus carinatum do not experience significant physical problems.

Potential Complications

While serious complications are rare, pectus carinatum may be associated with:

• Scoliosis: An increased likelihood of developing spinal curvature.
• Connective Tissue Disorders: Conditions like Marfan syndrome, which can have broader health implications.

Which Medical Specialty to Consult for Pectus Carinatum?

Individuals who suspect they have pectus carinatum should consult the following specialists:

• Thoracic Surgery: Specialists in chest wall deformities.
• Orthopedics and Traumatology: Experts in musculoskeletal conditions.
• Pediatric Surgery: Particularly for children and adolescents.

A comprehensive evaluation may involve collaboration among physiotherapists, psychologists, cardiologists, and pulmonologists to ensure a holistic and effective treatment plan.

Role of Thoracic Surgeons

Thoracic surgeons play a central role in the management of pectus carinatum:

• Diagnosis and Assessment: Perform a physical examination and order imaging tests such as X-rays or CT scans to evaluate the severity of the deformity.
• Treatment Planning: Determine the most suitable treatment strategy by taking into account factors such as the patient's age, severity of the condition, and personal preferences.
• Surgical Intervention: Perform procedures such as:
• Ravitch Procedure: An open surgical operation in which abnormal cartilage is removed and the sternum is repositioned to correct the chest wall deformity.
• Abramson Procedure: A minimally invasive technique using a metal bar to correct the chest protrusion.

Postoperative care includes monitoring recovery, managing pain, and addressing any complications.

Pediatric Surgery and Other Specialties

Given that pectus carinatum often becomes noticeable during childhood or adolescence, pediatric surgeons are integral to early diagnosis and treatment. They offer age-appropriate care and coordinate with other specialists:

• Cardiology: To assess and manage any associated heart conditions.
• Pulmonology: For evaluating and treating respiratory issues.
• Orthopedics: This is especially important if spinal deformities, such as scoliosis, are present. Early intervention”particularly the use of bracing during periods of growth”can lead to more effective outcomes.
• Physiotherapy: Physiotherapy supports treatment by developing exercise programs that correct posture and strengthen the chest and back muscles. This is especially important during the postoperative recovery period.
• Psychology/Psychiatry: Provides psychological support and therapy for patients experiencing body image concerns, low self-esteem, or social anxiety. This support is especially important for adolescents.
• Genetic Specialists: In rare cases, pectus carinatum (pigeon chest) may be associated with genetic syndromes. Genetic specialists play a role in diagnosing these conditions and providing genetic counseling.

Differences Between Pectus Carinatum (Pigeon Chest) and Pectus Excavatum (Funnel Chest)

There are fundamental differences between pectus carinatum (pigeon chest) and pectus excavatum (funnel chest).

Appearance Differences:

• Pectus Carinatum (Pigeon Chest):

The sternum (breastbone) protrudes outward, making the chest wall appear prominently convex. This causes the chest to take on a shape similar to that of a pigeon's breast.

• Pectus Excavatum (Funnel Chest):

The chest wall appears sunken inward. The sternum is pulled back more than normal, giving the chest a caved-in or hollow appearance, resembling the shape of a shoe cobbler's depression (hence the term "funnel chest).

• Causes and Development:

Pectus Carinatum is usually congenital and may be linked to genetic factors. It often becomes more prominent during adolescence, especially during periods of rapid growth.

Pectus Excavatum is also typically congenital and may involve genetic factors, but it can also be associated with connective tissue disorders, rickets, or certain heart conditions.

• Physical Effects:

Pectus Carinatum often causes cosmetic concerns, but the risk of serious breathing problems or heart complications is generally low.

Pectus Excavatum may be associated with more serious respiratory and cardiac issues, as the sunken chest wall can compress the heart and lungs, potentially causing symptoms like shortness of breath and exercise intolerance.

• Treatment Methods:

Pectus Carinatum is usually treatable with an orthopedic brace. In severe cases, surgical correction may be required.

Pectus Excavatum often necessitates surgical intervention due to the more pronounced deformity and its potential impact on internal organs. Surgical procedures aim to reshape the sternum and restore its normal position.

*  Liv Hospital Editorial Board  has contributed to the publication of this content .
* The content on this page is for informational purposes only. Please consult your doctor for diagnosis and treatment. This page does not provide information about medicinal healthcare services at Liv Hospital.

For more information about our academic and training initiatives, visit Liv Hospital Academy

Frequently Asked Questions