Pectus Carinatum (seek nonoperative treatment )

Pectus Carinatum：

Recently, a friend asked me what the best supplement is for a 12-year-old boy with pectus carinatum. I searched my memory, and I could not think of anything/ knowledge related to this disease. Therefore, my advice to her was a very common and not so responsive answer, “I would encourage parents to consult with his or her doctor for the best advice”.

So, what is pectus carinatum?  I did my little research after I go back home:

Pectus carinatum is an abnormal finding in which a forward protrusion of the sternum, with ribs sloping back at one or both sides and vertical depressions along costochondral junctions (also called pigeon breast, or chicken breast). According to Lee, Song, and Lee (2014), pectus carinatum appears most commonly at pubertal age. It occurs by an overgrowth of costal cartilage, and occurs mainly in males and is less common than pectus excavatum.

There are other abnormal findings of the thorax. Below only briefly explanation for comparison:

• Pectus Excavatum: a markedly sunken sternum and adjacent cartilages (also called funnel breast). Depression begins at second intercostal space, becoming depressed most at the junction of xiphoid with the body of the sternum. More noticeable on inspiration.
• Barrel chest: note equal AP – to – transverse diameter and that ribs are horizontal instead of normal downward slope. This is associated with normal aging and also with chronic emphysema and asthma as a result of hyperinflation of lungs.
• Scoliosis: a lateral S-shaped curvature of the thoracic and lumbar spine, usually with involved vertebrae rotation. Note unequal shoulder and scapular height and unequal hip levels, rib interspaces flared on the convex side. More prevalent in adolescent age-groups, especially girls.
• Kyphosis: an exaggerated posterior curvature of the thoracic spine that cause significant back pain and limited mobility (also called humpback).

(Jarvis, 2016)

According to Fonkalsrud (2003), “pectus carinatum is approximately 7 times less frequent than pectus excavatum, and occurs more than 6 times more often in males. More than 30% of pectus carinatum patients have a familial occurrence of pectus deformities. Less than 5% have congenital heart disease. More than 60% have mild to moderate scoliosis”.

Treatment of pectus carinatum: as an abnormal finding of the thorax, minor deformity requires no treatment. However, if severe, surgery may be indicated.

During my research, I went over books and scholarly articles, operative treatment seems like the treatment of choice.  I start thinking if there are nonoperative ways of treatment???? For example, physical therapy along with supplement intake., or if a compression brace will help? Can’t wait to find out relative information. More researches are needed. TO BE CONT…….

References:

Fonkalsrud, E. W. (2003). Current Opinion: Pectus Carinatum: The Undertreated Chest Malformation. Asian Journal Of Surgery, 26189-192. doi:10.1016/S1015-9584(09)60300-6

Lee, S. Y., Song, I. H., & Lee, S. J. (2014). Minimal invasive extrathoracic presternal compression using a metal bar for correction of pectus carinatum. Pediatric Surgery International, 30(1), 25-30. doi:10.1007/s00383-013-3419-0

Jarvis, C. (2008) Jarvis physical examination and health assessment. (1st ed.)

Jarvis, C. (2016) Jarvis physical examination and health assessment. (7th ed.)