Pectus carinatum, sometimes called pigeon chest, is a non-life-threatening condition. It’s marked by an abnormally outward protruding breastbone caused by rapid cartilage growth forcing the chest cavity outward. Occasionally, symptoms are present from birth or early childhood, but it’s most commonly diagnosed around 11 or 12 years of age.

For most children, pectus carinatum is an aesthetic issue only. This condition frequently results in an asymmetrical chest. In more severe cases, symptoms may also include difficulty breathing during physical activities, recurring respiratory infections, and asthma.

While its cause is unknown, it appears to be more common in boys, and there seems to be a hereditary component. If needed, treatment for pectus carinatum usually includes wearing a brace for children whose bones are still developing. But it can also include surgery for severe cases.

Pectus carinatum is often asymptomatic, meaning it doesn’t have any noticeable symptoms. When symptoms do occur, they may include:

  • asthma
  • fatigue
  • frequent respiratory infections
  • difficulty breathing during physical activity

The most common symptoms are related to body image.

Types

There are two types of pectus carinatum: chondrogladiolar prominence (CG) and chondromanubrial prominence (CM). Most people with this condition have chondrogladiolar prominence pectus carinatum. CM is rarer and more difficult to treat.

In people with CG, the middle and lower areas of the rib cage arch forward. The longer, more flexible ribs are affected, which are easier to correct than the shorter, less flexible ribs in the upper rib cage.

CM affects the upper rib cage and is typically symmetrical. This type is more difficult to treat because the affected ribs are shorter and less flexible.

Pectus carinatum may also be classified by cause and time of onset. Those classifications include:

  • post-surgical, which happens when the sternum doesn’t heal properly after surgery or chest trauma
  • congenital, where premature fusion of the chest cavity is present at birth
  • idiopathic, the most common type of pectus carinatum, which appears between ages 11 and 15 and correlates with growth spurts

The exact cause of pectus carinatum is unknown. However, many physicians believe it occurs because of an issue with the cartilage that connects the ribs and the breastbone. When the cartilage in the ribs grows more rapidly than the bones, it causes the breastbone to by pushed outward. Not enough research has been done to determine the reason for the rapid cartilage growth.

A family history of this disorder or other chest wall deformities increases risk for pectus carinatum. Connective tissue disorders like Marfan’s syndrome also increase risk for this condition.

When diagnosed in infancy, it may also be seen with premature breastbone fusion and congenital heart disease. Pectus carinatum is also much more common in Caucasians than people of other races.

Pectus carinatum occurs in roughly 1 per 1,500 children. It’s more common in boys than in girls, and typically isn’t seen until after a child's 11th birthday. The condition often worsens during the growth spurt that comes with adolescence.

Pectus carinatum is often diagnosed by physical exam, but you might need a front and side chest X-ray as part of the workup for this condition. A CT scan or MRI scan may also be used in some cases.

During your exam, your doctor may also check for scoliosis. If you have an irregular heartbeat in addition to suspected pectus carinatum, an electrocardiogram (EKG) or echocardiogram may also be performed.

Bracing

For most cases of pectus carinatum, treatment may not be necessary. The most common approach for mild to moderate cases that require treatment is the use of a brace. You’ll need to wear the brace for a minimum of eight hours a day for at least six months. This semi-padded brace corrects the outward presence of the chest over time through consistent pressure to the cartilage. This constant pressure causes the cartilage to gradually reshape.

Prior to a brace being used, a doctor assesses the amount of pressure that will be required to resolve the issue on a case-by-case basis. Results are typically seen within the first few months.

Surgery

Surgical treatment for pectus carinatum often includes a procedure in which a surgeon removes the cartilage that is pushing the breastbone outward. This is done via incision in the middle chest area. Afterward, struts are placed across the chest to support the front of the breastbone and later removed via surgery.

Exercise

In recent years, people have begun experimenting with exercise as a potential treatment for pectus carinatum. These exercises target the muscles surrounding the protruding area and decrease the appearance of the outward chest cavity.

This solution hasn’t been researched, and it may not be appropriate for moderate to severe cases. It’s important to speak with your doctor before considering this treatment route, and to work with someone experienced in using exercise to treat this condition.

Recovery and success rates for both traditional methods of treatment, bracing and surgery, range from good to excellent. Bracing is the least invasive treatment and poses the smallest risk. The main side effect of using a brace is skin irritation.

The likelihood of complications increase for surgery. As with any surgery, there are risks. While uncommon, bleeding, infection, or the buildup of fluid or air around your lungs are possibilities.

Pectus carinatum is non-life-threatening. The majority of children who are diagnosed are able to live normal lives. If the case is mild to moderate, there’s the possibility that no medical treatment will be necessary. For children who do require medical intervention, results can usually be seen within a short period of time. Those who opt for treatment have high rates of satisfaction.