What is Pigeon Chest?
(Pectus Carinatum)

Pectus carinatum is a rare chest wall deformity that causes the breastbone to push outward instead of being flush against the chest. It is also known as pigeon chest.

When the chest wall develops, the cartilage that connects the ribs usually grows flat along the chest. In cases of pectus carinatum, this cartilage grows abnormally, causing unequal growth in the areas where the ribs connect to the sternum. This causes the outward appearance of the chest wall.

The cause is generally unknown and is therefore termed “idiopathic”. There are some syndromes which have Pectus Carinatum (or Excavatum – ‘caved-in’) as an anomaly with the syndrome. (such as Marfan Syndrome).

Most often, pectus carinatum develops during childhood and gets more pronounced as children go through puberty. In some cases, it may not be noticed until a child goes through their adolescent growth spurt.

In some children, the appearance of pectus carinatum may be worse on one side, with the opposite side appearing to have a dip in it. This dip is called pectus excavatum.

  • Pectus carinatum affects around 1 in every 300 to 400 births in children.
  • The condition affects four times as many males as females.
  • Pectus carinatum is the second most common chest abnormality seen in children and adolescents.

The condition may also be associated with certain medical conditions including:

  • heart disease
  • scoliosis, abnormal curvature of the spine
  • kyphosis, where the back is hunched
  • other musculoskeletal abnormalities
  • connective tissue disorders, such as Marfan syndrome
  • abnormal growth patterns

Types:

Chondrogladiolar prominence.

This type of pectus carinatum is also called “chicken breast” and is the most common form of the condition. Here, the middle and lower sections of the breastbone push forward.

Chondromanubrial prominence.

This type of pectus carinatum is also called “Pouter pigeon breast” and is a more rare and complex form of the condition. Here, the breastbone develops in a Z-shape, with the top section pushing forward.

To diagnose pectus carinatum, a medical professional will need to examine how the breastbone is growing. To do this, they will likely request a chest X-ray. A doctor may also request pulmonary function tests if the condition is causing respiratory symptoms. People who experience symptoms related to the heart may also need an electrocardiogram or echocardiogram.

Depending on the appearance of the pectus carinatum, doctors may also decide to test for related conditions, such as scoliosis, congenital heart disease, and Marfan syndrome.

While some children and adolescents can experience symptoms and side effects from pectus carinatum, the condition is mainly cosmetic. Treatment is based on appearance as well as symptoms.

A common associated finding with PC is spinal deformity (Scoliosis, HyperKyphosis), which may range from mild to severe. In the presence of spinal deformity, both conditions need to be treated simultaneously.

The standard treatment approach for pectus carinatum in children with a mild to moderate form of the condition is orthotic bracing. This involves a custom-fitted brace that fits on the outside of the chest.

The purpose of the brace is to place pressure on the area most affected by the condition, to flatten it to the chest. This process is called re-modelling.

To see any effects, a child will need to wear a brace full time for the first 3 to 12 months. Wear time decreases as corrections are made after this initial period, according to doctor’s instructions. A child may need to wear the brace until they have gone through puberty.

Surgery is usually only an option for people when a chest brace has been ineffective or when they have passed puberty. A doctor may also consider surgery for people whose symptoms are severe. Surgery is more commonly performed in the Pectus Excavatum (caved-in) chest where bracing is quite ineffective.

In most cases, a child’s health is not affected by pectus carinatum. Treatment with a chest brace tends to have good results.

What do I do if my child has Pectus Carinatum?

The deformity is usually diagnosed clinically (visible deformity).  The deformity is not well defined on chest X-Rays, as it is a soft tissue deformity. A special MRI may be done to measure chest cavity dimensions, although this is seldom necessary for PC.  Medical practitioners will often tell patients that it is not necessary to treat this, but in most cases, the psychological effects of the deformity justify brace treatment.

We will also be able to advise you and discuss bracing and the associated physiotherapy.

EFFECT OF BRACING AFTER 3 MONTHS OF TREATMENT

FAQ

Most frequent questions and answers

The cause is unknown. It is sometimes secondary to thoracic (chest) surgery, or an injury, or may be associated with (anomaly) an underlying condition – such as Marfan Syndrome.

Because it is a soft tissue (cartilage) disorder, it is not easily detected on X-Ray. There is a scan which can be done with a special view called a Haller view. This is normally only done for the other chest deformity called Pectus Excavatum. It is generally not necessary to have an X-Ray or CT/MRI scan for P.C.

No. it occurs in females too. In most cases development of the breasts will make the deformity appear less prominent, but in some cases can cause cosmetic concerns. It can be managed conservatively using a brace.