Pectus Carinatum Lecture Notes

Introduction

• Pectus Carinatum: Also known as pigeon chest, bird chest, keel chest.
• Characterized by a protrusion of sternum and ribs.
• Distinct from pectus excavatum.

Characteristics

• Frequency: Occurs in 1 in 1,000 children.
• More common in males.
• Typically develops in males aged 11 to 14 during growth spurts.

Cause and Types

• Causes: Generally unknown, sometimes linked to vitamin D deficiency (rickets).
• Types:
  • Chondrogladiolar prominence.
  • Chondromanubrial prominence.

Complications

• Potential complications include:
  • Marfan syndrome, Ehlers-Danlos syndrome.
  • Self-esteem issues, body dysmorphia.
  • Back pain, scoliosis, mitral valve prolapse.

Diagnosis

• Diagnosed using imaging tests like CT scans.
• Can be symmetrical or unsymmetrical.

Treatment

• Bracing: Effective non-surgical treatment; pioneered by Sydney Haje.
  • Uses a custom chest-wall brace, similar to orthodontic braces.
  • Requires patient motivation and compliance to wear the brace 14 to 24 hours daily.
• Surgery: Considered when bracing fails or in severe cases.
  • Techniques include Ravitch and Reverse Nuss procedures.

Prognosis

• Generally excellent with appropriate treatment.

Psychological and Physical Impacts

• Psychological effects can be significant, affecting self-esteem and body image.
• Physical impacts include inefficient respiration during exercise, decreased stamina.

Associated Conditions

• Frequently associated with connective tissue disorders and scoliosis.
• Can occur with syndromes like Turner, Noonan, and Marfan syndrome.

External Bracing Technique

• Increasingly preferred over surgery due to less risk.
• Requires regular supervision and adjustments as child grows.

Conclusion

• Pectus carinatum is less common than pectus excavatum.
• Early diagnosis and treatment can prevent further complications.
• Continuous monitoring and brace adjustments are crucial for successful outcomes.