A funnel chest is a funnel-shaped deformity of the thoracic wall due to a defective formation of the cartilage connections between the breastbone and ribs. Men are slightly more likely than women to have a pectus excavatum, with a ratio of 3:1.
What is a pectus excavatum?
A funnel chest (pectus excavatum) is a visible deformation of the thoracic wall, which usually affects the 4th to 7th ribs in the lower sternum and which, in contrast to the so-called keel or chicken breast, already manifests itself in childhood.
Malformations in the cartilaginous connections between the ribs and the sternum cause a funnel-shaped depression in the front of the thorax, which can be symmetrical or asymmetrical. For idiopathic thrombocytopenic purpura definition and meaning, please visit eshaoxing.info.
Due to this funnel, internal chest organs such as the heart can be displaced depending on the specific characteristics present and, in extreme cases, can lead to cardiopulmonary (heart and lungs) alterations with serious consequences, which cause reduced ventilation of the lungs.
In addition, a funnel chest can be associated with kyphoscoliosis or other diseases as a result of postural defects (low back pain, dorsalgia).
The exact causes of a funnel chest could not be finally clarified. In most cases, however, the disease is due to genetic factors that lead to soft costal cartilage as a result of a disturbed cartilage metabolism.
Accordingly, around 35 to 37 percent of those affected have a first-degree relative with this disease in their family environment. However, the specific gene that triggers the manifestation of a pectus excavation has not yet been decoded.
In addition, in some cases a pectus excavatum is associated with certain syndromes such as Marfan syndrome. A funnel chest can also be observed after certain illnesses (pleural rind), as a consequence of surgical interventions on the diaphragm or chest wall, and as a result of greatly increased alcohol consumption during pregnancy (fetal alcohol syndrome).
Symptoms, Ailments & Signs
The funnel chest is already clearly recognizable at birth. An inward compression of the chest is symptomatic. Usually there are no other noticeable symptoms in the first years of life. Only from puberty and with increasing adulthood do a number of signs appear that are related to the congenital malformation.
Puberty in particular is a psychological burden for people with a funnel chest. Those affected feel ashamed of their bodies and withdraw. Social interaction with peers suffers. In addition, the deformity increases during growth, which intensifies the psychological symptoms. Affected people are not as physically strong compared to their peers.
This extends to all of life. Even small loads can lead to breathing difficulties and shortness of breath. In the development phase into a man or a woman, the heart sometimes cannot expand any further due to the limited body. In old age, heart problems are to be expected on a regular basis.
It has also been proven that the heart may squeeze other organs. In principle, those affected have to accept restricted mobility throughout their lives. Bad posture often develops in the form of a hunched back. This often results in damage to the intervertebral discs.
Diagnosis & History
A funnel chest can usually be diagnosed on the basis of the externally visible funnel-shaped indentation in the area of the chest wall, which usually occurs in the first year of life and increases until growth is complete.
Full assessment of the deformity is done using computed tomography of the chest wall. Impairments of the airways can be detected in the context of lung function tests such as spirometry or body plethysmography. Cardiodiagnostic procedures ( echocardiogram ) provide information about an involvement of the heart (mitral valve prolapse).
In addition, other underlying diseases ( keel chest, Harrenstein deformity) should be ruled out by an X-ray examination of the spine. In most cases, a funnel chest is mild and progresses well. If left untreated, a funnel chest can lead to malformations of the spine and disorders of the heart or lungs as a result of poor posture.
When should you go to the doctor?
A doctor should always be consulted if there is a funnel chest. This disease definitely needs to be evaluated and treated by a medical professional to avoid further complications or discomfort. With this disease, early diagnosis with subsequent treatment has a very positive effect on the further course of the disease and can also prevent further complications. Self-healing usually does not occur. A doctor should be consulted if the person concerned suffers from a malformation of the breast.
The chest is pushed inwards, which can usually be seen with the naked eye. Furthermore, breathing difficulties or, in severe cases, even shortness of breath can indicate the pectus excavatum. Heart pain is also a sign of this disease. If the funnel chest is not treated, it usually leads to restrictions in the movement of the person concerned.
In the case of a funnel chest, an orthopedist or a general practitioner can be consulted. Further treatment is then usually surgical. Since the disease can also lead to depression or other psychological problems, a visit to a psychologist is usually necessary.
Treatment & Therapy
In the case of a funnel chest, the therapeutic measures depend on the specific severity of the deformity. Slight malformations without clinical or psychological impairment are usually treated as part of physiotherapy measures to correct postural defects (postural gymnastics).
An indication for surgical intervention is derived from the psychological stress caused by the funnel chest and the degree of deformation, and in severe cases the conservative measures are complemented by surgical correction of the malformation. In most cases, the correction is performed using the minimally invasive Nuss surgical procedure.
For this purpose, an individually adapted U- or C-shaped metal arch is implanted through an opening in the chest through two smaller incisions in the armpit area, which brings the chest into the regular position by raising it and creates space for proximal organs such as the heart. In adolescents, the implant remains in the affected person’s body until growth is complete to prevent funnel formation again.
In addition, the open correction procedure according to Ravitch – Welsh – Rehbein is also used occasionally, in which the affected ribs are modeled or removed via a horizontal (in men) or vertical (in women) incision on the chest and replaced with implants to avoid the funnel chest to correct.
A purely cosmetic surgical procedure is to fill the cavity with silicone implants. In addition, long-term treatment with a suction or vacuum bell represents a relatively new alternative therapy option, with the help of which the sternum is to be lifted regularly and the funnel reduced accordingly. However, there are still no long-term studies on this treatment option for pectus excavatum.
A genetically caused funnel chest cannot be prevented. However, physiotherapeutic measures, especially strengthening the back and chest muscles, help to minimize the risk of organ involvement. In addition, excessive alcohol consumption should be avoided during pregnancy in order to avoid fetal alcohol syndrome, which can cause a funnel chest, among other malformations.
Depending on the extent of the funnel chest, surgical treatment is carried out. The aftercare of the wound, including the removal of the sutures, is carried out by the attending physician. For up to six weeks after the operation, it is advisable not to do any sport and, if possible, to sleep on your back. During this time, the use of painkillers is usually reduced.
This is also regulated by the doctor. After the six weeks, the patient can begin physical therapy. The patient can also slowly start exercising again. However, the intensity and amount of sport should be discussed with the doctor treating you. However, certain sports such as boxing are not recommended for the long term in order to avoid damage to the chest area.
It is also advantageous if the patient does not carry any heavy loads for at least three months after the operation. After about a year, follow-up treatments are only necessary if necessary. An exception to this is the removal of the brackets three years after the actual operation. It is removed by another operation. Patients with a funnel chest can also experience psychological stress, which can be treated by a professional therapist.
You can do that yourself
Irrespective of the conservative treatment of pectus excavatum, which nowadays is mostly done surgically or with the help of suction cups, it is advisable to correct bad posture such as a hollow back or sagging shoulders through physiotherapy. Those affected must make a conscious effort to maintain a natural posture in order to improve their posture in the long term. Regular training and the resulting successes also boost the self-confidence of those affected.
After an operation, patients have to take it easy. The wound must be treated professionally and carefully monitored as there is a risk of inflammation or bleeding.
The funnel chest does not necessarily have to be treated. Those affected who decide against therapy should use therapeutic options to make it easier to deal with the deformity of the chest. Visiting a self-help group and contacting other sufferers can also be useful if the funnel chest is a significant burden. In most cases, the parents also have to ensure that the child develops healthily despite the malformation. Especially during puberty, exclusion and bullying can occur. When these situations arise, parents of affected children need to speak to teachers and other parents.