Chest Wall Malformations

What Are Chest Wall Malformations?

Chest wall malformations are congenital (present at birth) deformities of the bones, muscles, or cartilage that make up the front and/or sides of the chest. These abnormalities can affect the shape and function of the rib cage, potentially impacting breathing, heart function, and overall body mechanics. The most common chest wall malformations seen in pediatric patients include pectus excavatum (a sunken chest) and pectus carinatum (a protruding chest).

Though not every chest wall malformation causes symptoms, many children experience physical discomfort, restricted exercise tolerance, or self‑image concerns. Surgical evaluation is often recommended when the deformity affects cardiopulmonary function, causes pain, or has significant cosmetic impact.

Types of Chest Wall Malformations

Pectus Excavatum

This condition causes the sternum (breastbone) to grow inward, creating a hollowed‑in appearance. It can range from mild to severe and sometimes affects lung and heart expansion.

Pectus Carinatum

Here, the sternum protrudes outward, creating a “pigeon chest” appearance. This type may be more noticeable during growth spurts and can cause discomfort with physical activity or respiratory effort.

Less common chest wall malformations may involve rib abnormalities, congenital scoliosis, or syndromic associations, and often require individualized evaluation.

Signs and Symptoms

Not all chest wall malformations cause physical symptoms, but some children experience:

  • Visible chest asymmetry or deformity
  • Difficulty with deep breathing or exercise intolerance
  • Chest pain or discomfort
  • Fatigue during activity
  • Self‑image concerns or emotional distress

Symptoms often become more apparent during growth spurts in adolescence, but many are detected earlier in childhood during routine pediatric exams or imaging.

How Chest Wall Malformations Are Diagnosed

Diagnosis begins with a thorough physical examination by a pediatric surgeon or specialist. Additional tools used to evaluate the malformation include:

  • Chest X‑ray to assess bone structure
  • CT scan or MRI for detailed anatomical visualization
  • Pulmonary function tests to measure breathing and lung capacity
  • Echocardiogram in select cases to evaluate heart function

These studies help determine the severity of the deformity and guide treatment planning.

Treatment Options

Observation and Bracing

Mild cases that do not impact breathing or growth may be monitored over time. For pectus carinatum, external bracing may help remodel the chest wall during growth, particularly in children and teens.

Surgical Correction

When a malformation causes symptoms, cosmetic concerns, or functional restriction, surgery may be recommended. Common surgical approaches include:

  • Minimally invasive repair (Nuss procedure) for pectus excavatum
  • Open repair (Ravitch procedure) to reshape the chest framework
  • Customized repairs for complex rib or sternum involvement

Each case is evaluated individually — surgical candidacy is determined based on symptoms, imaging findings, and overall health.

Divisions Involved in Your Care

Procedures We Use

Frequently Asked Questions

These conditions develop during fetal growth when the chest bones and cartilage do not form in the typical pattern. The exact cause is often unknown and may occur sporadically.

In more severe cases, the shape of the chest can restrict lung expansion and reduce exercise tolerance. Pulmonary function testing helps assess whether breathing is impacted.

Surgery may be recommended for patients with respiratory symptoms, chest pain, limited physical activity, or significant cosmetic concern. A pediatric surgeon will help determine the best timing and approach.

Pectus excavatum creates a sunken chest appearance, while pectus carinatum causes the chest to protrude outward. Both can vary in severity and impact.

Bracing can be effective for some cases of pectus carinatum, particularly in growing children, by reshaping the chest wall over time.

Recovery depends on the procedure, but most children resume normal activity gradually with guidance from their surgeon. Pain management, wound care, and follow‑up imaging are part of post‑operative care.