Pectus excavatum (funnel chest)

Characteristics and severity

Appearance varies from a shallow, symmetrical depression to deep, asymmetric deformity that can alter chest contours. In many people the condition is primarily cosmetic; in more severe examples the inward displacement can reduce thoracic volume and affect cardiac and respiratory function. Clinicians often use imaging and indices, such as the Haller index, to quantify severity.

Causes and development

The exact cause is not fully understood. The condition arises from abnormal growth of the costal cartilages and sternum. It is more common in males (around a 3:1 ratio) and has a reported occurrence of roughly 1 in 300–400 births. Pectus excavatum can occur sporadically or in association with connective tissue conditions such as Marfan syndrome or with spinal differences like scoliosis.

Diagnosis and evaluation

Evaluation begins with medical history and physical examination. Imaging (chest X-ray or CT) helps assess the depth and potential compression of thoracic organs; a cardiopulmonary exercise test or echocardiography may be used when functional impairment is suspected. For general information see clinical overviews and for developmental aspects consult growth and adolescence resources.

Treatment options

• Conservative therapies: posture correction, targeted physical therapy, and breathing exercises can improve symptoms and appearance in mild cases.
• Non‑surgical devices: vacuum bell suction may reduce the depression in select patients, especially younger individuals with more flexible chest walls.
• Surgical correction: commonly used procedures include the minimally invasive Nuss operation and the open Ravitch repair. Surgery is usually considered when deformity is severe, progressive, or causing functional or psychological problems, and timing often follows the main adolescent growth period.

Impact and prognosis

Many people with pectus excavatum lead normal, active lives; for others the condition can cause shortness of breath, chest pain, reduced exercise tolerance, and significant psychosocial distress. Outcomes after treatment vary with technique, severity, and patient factors; recurrence and complications are possible, so individualized assessment and follow-up are important.

Notable distinctions

Pectus excavatum should be distinguished from pectus carinatum, in which the sternum protrudes outward. Both are chest wall deformities but differ in form, typical management, and clinical implications.