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249: PECTUS EXCAVATUM

Kay Tasso, PhD, PT, PCS

CONDITION/DISORDER SYNONYMS

  • Cobbler’s chest

  • Dent in the chest

  • Funnel chest

  • Hollowed chest

  • Sunken chest

ICD-9-CM CODE1

  • 754.81 Pectus excavatum

ICD-10-CM CODE2

  • Q67.6 Pectus excavatum

PREFERRED PRACTICE PATTERN

  • 4B: Impaired Posture

PATIENT PRESENTATION

An 18-month-old is referred to physical therapy for developmental delay. Upon examination, the therapist notes the child has hypotonia and pectus excavatum. The mother states she had a viral illness during her first trimester but a normal vaginal delivery. She reports that the orthopedist states no current surgical intervention is necessary for the pectus unless the child’s respiratory system becomes compromised as the child ages. The physical therapist plans on treating the gross motor delay with weekly therapeutic activities and strengthening.

KEY FEATURES

Description

  • Most common thoracic deformity

  • Sternal depression resulting in sunken appearance

  • Can cause right sternal rotation resulting in heart to shift to left

  • Can cause pain in the back and ribs

  • May result in shortening of anterior thoracic muscles and over-lengthening of posterior thoracic muscles

Essentials of Diagnosis

  • May be associated with congenital heart disease or murmur due to disrupted blood flow

  • Mitral valve prolapse may be present

  • Lung capacity can decrease with changed rib cage shape

General Considerations

  • Primarily, only of concern for cosmetic or psychological reasons

  • Deformity continues to grow until post-pubescence

  • Seen in Marfan syndrome and Ehlers–Danlos syndrome

FIGURE 249-1

Marked pectus excavatum. (From Fuster V, Walsh RA, Harrigton RA. Hurst’s The Heart. 13th ed. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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Demographics

  • Males to females, 4:1

  • Familial tendency

  • Seen at birth or developed at puberty

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Present upon clinical observation

  • Often asymptomatic

  • Cardiovascular limitations3

  • Adolescents may report fatigue, exercise intolerance, chest or back pain

  • Rarely may report dyspnea or palpitations

Functional Implications

  • If severe, may result in decreased lung capacity that requires surgical intervention

Possible Contributing Causes

  • Celiac disease

  • Due to outgrowth of ribs or costal cartilage

  • Hypothesized genetic defect

  • Marfan syndrome

  • Rickets

  • Spinal muscular atrophy

Differential Diagnoses

  • Scoliosis

  • Pectus carinatum

  • Kyphoscoliosis

FIGURE 249-2

Transverse and sagittal views of the diaphragm. (From DeTurk WE, Cahalin LP. Cardiovascular and Pulmonary Physical Therapy: An Evidence-Based Approach. 2nd ed. http://www.accessphysiotherapy.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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