Pectus Carinatum (Pigeon Chest)

What is pectus carinatum?

Pectus carinatum (PC) is a chest wall deformity where there is overgrowth of the cartilage between the ribs and the sternum causing the sternum to stick out. Although the shape of the chest wall is distorted, it does not usually affect the internal organs.

Pectus carinatum is most common in adolescent males. It becomes more noticeable during puberty when the body goes through a growth spurt. It does not cause any functional problems but it could impact on your child’s social life or be a cause of concern or anxiety, especially when exposing the chest protrusion at the beach, pool or changing room.

Treatment

See Dr Bellemore for an initial consultation. If he diagnoses pectus carinatum he can refer you to the Orthotic Department of the Children’s Hospital at Westmead to be treated using a chest orthosis, also known as a brace. The orthosis/brace helps to correct the shape of the chest wall by compressing, or squeezing, the overgrown ribs and sternum back to a ‘normal’ position. The orthosis is worn until satisfactory results are achieved and the chest wall can stay in position by itself.

Wearing the orthosis

 There are two main phases of wear: corrective and maintenance.

  • Corrective phase: The first three to six months during which the orthosis is worn 23 hours a day.
  • Maintenance phase: When the chest overgrowth has flattened enough, the orthosis is worn for eight hours each night. During this phase, patients continue to monitor their chests to make sure there is no relapse. This phase usually lasts another three to six months.
  • The orthosis should not be worn during high intensity activities such as sport.
  • Your orthotist will show your child how to wear the orthosis correctly and adjust it appropriately.

Chest orthosis process

  • A cast is taken for the chest orthosis (brace).
  • The first fit occurs three to four weeks after the cast is taken. Initial 2D and 3D photos are taken of the fitted cast.
  • A review takes place one week after the fitting. This will be the initial review to ensure there are no issues or problems.
  • Another review takes place three weeks later with the Orthotic Department.
  • Reviews are ongoing every four weeks in the Prosthetic and Orthotic Department.
  • Reviews by Dr Bellemore every three months until a satisfactory correction is achieved.
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