XI./2.1.: Funnel chest (pectus excavatum) XI./2.1.1. Definition XI./2.1

XI./2.1.: Funnel chest (pectus excavatum)
XI./2.1.1. Definition
Thoracic deformity with inward displacement of the sternum.
XI./2.1.2. Etiology
Sporadic and genetic factors play a role in the development of funnel chest.
XI./2.1.3. Clinical features
Total or partial, symmetrical or asymmetrical inward displacement of the
sternum. The sternal end of the ribs and the lower part of the chest are also
often affected. It is already noticeable during the first year of life. Usually
thin, asthenic children, if the deformity is greater, patients are
characteristically less sturdy and more prone to fatigue. A deformity with
over 50% reduction of the thoracic anteroposterior diameter can lead to
major cardiorespiratory symptoms and paradox breathing may occur.
Figure 1.: Clinical appearance of funnel chest
XI.2.1.4. Investigations
Radiographs: lateral chest X-ray should be performed in case of major
deformity, and the extent of displacement - thoracic AP diameter ratio
should be evaluated. AP and lateral spine X-rays should be performed in
adolescence if associated spinal deformity is suspected.
ECG, exercise ECG, echocardiography, and lung function tests in case of
significant deformity, lung problems and weakness.
XI./2.1.5. Associated diseases
Scheuermann’s disease (the child „hides” his chest deformity by adopting a
hyperkyphotic posture), scoliosis, prune belly syndrome.
XI./2.1.6. Treatment
Conservative treatment: strengthening of the chest and trunk muscles,
breathing exercises, spinal exercises in adolescence (prevention of spinal
deformities).
Surgery: restricted cardiopulmonary function is an absolute indication for
sugery. Psychological burden is considered a relative indication at the end
of puberty based on the child's own decision. Nuss surgery (thoracoscopic
method, where a rigid pre-bent metal bar is fixed to the inner wall of the
chest to correct the deformity; the implant should be removed after 2-3
years).
Figure 2.: Funnel chest correction according to Nuss. The position of the implant seen on a
postoperative AP chest X-ray
Literature
Obligatory literature
Miklós Szendrői: Orthopedics Chapter 24.10.