7 Key Signs and Symptoms of Pectus Excavatum (Sunken Chest)

Pectus excavatum, also known as sunken chest or concave chest, is the most common congenital chest wall deformity. This condition occurs when the breastbone (sternum) grows abnormally, creating an indented or caved-in appearance in the chest. While some individuals with pectus excavatum may only experience cosmetic concerns, others can develop significant physical symptoms that affect their quality of life.

The severity of pectus excavatum varies greatly from person to person. In mild cases, the indentation may be barely noticeable and cause no symptoms. However, moderate to severe cases can lead to breathing difficulties, reduced exercise tolerance, and cardiovascular complications. Understanding the signs and symptoms of this condition is crucial for early detection and proper management.

Below, we explore the most common symptoms associated with pectus excavatum, helping you recognize when medical evaluation may be necessary.

1. Visible Chest Wall Depression

The most obvious and characteristic symptom of pectus excavatum is a noticeable indentation in the center of the chest. This depression typically occurs at the lower portion of the sternum and can vary in depth and width.

The sunken chest appearance may be present at birth or develop gradually during childhood and adolescent growth spurts. In some cases, the depression becomes more pronounced during the teenage years when rapid skeletal growth occurs.

Key characteristics of the chest wall depression include:

• The indentation is usually symmetrical but can be asymmetric in some cases
• The depth can range from shallow (barely noticeable) to severe (several inches deep)
• The depression may become more visible when breathing deeply or during physical exertion
• The lower ribs may flare outward, creating an unusual chest contour

This visible deformity often causes significant psychological distress, particularly in adolescents and young adults who may feel self-conscious about their appearance.

2. Shortness of Breath and Breathing Difficulties

Many individuals with moderate to severe pectus excavatum experience respiratory symptoms, particularly during physical activity. The depressed sternum can compress the lungs, reducing their capacity to fully expand.

Breathing difficulties associated with pectus excavatum include:

• Exercise-induced dyspnea: Shortness of breath that occurs during physical activity or sports
• Reduced lung capacity: Pulmonary function tests may show decreased lung volumes
• Rapid breathing: Taking more frequent breaths to compensate for reduced lung capacity
• Difficulty taking deep breaths: Feeling unable to fully fill the lungs with air

These respiratory symptoms tend to worsen as the severity of the chest depression increases. Some patients report that breathing difficulties limit their ability to participate in sports or maintain the same activity level as their peers.

3. Chest Pain and Discomfort

Chest pain is a common complaint among individuals with pectus excavatum, though the exact cause is not always clear. The pain may result from musculoskeletal strain, costochondral inflammation, or compression of internal structures.

Characteristics of chest pain in pectus excavatum include:

• Sharp or aching pain in the chest wall area
• Discomfort that worsens with certain positions or movements
• Pain that may radiate to the back or shoulders
• Tenderness around the sternum or rib cage
• Pain that intensifies during deep breathing or physical activity

The chest pain associated with pectus excavatum is typically benign but can significantly impact daily activities. Some patients also experience a sensation of pressure or tightness in the chest, particularly when lying on their back.

4. Reduced Exercise Tolerance and Fatigue

Individuals with pectus excavatum often notice that they tire more easily than others during physical activities. This reduced exercise tolerance stems from the combined effects of decreased lung capacity and potential cardiac compression.

Exercise limitations may manifest as:

• Feeling exhausted after minimal physical exertion
• Inability to keep up with peers during sports or physical education classes
• Need for frequent rest breaks during activities
• Avoidance of strenuous activities due to discomfort or fatigue
• Decreased stamina and endurance compared to expected fitness level

The severity of exercise intolerance generally correlates with the depth of the chest depression. Patients with severe pectus excavatum may experience significant limitations that affect their participation in sports, recreational activities, and even routine daily tasks.

This reduced physical capacity can have psychological consequences, particularly in children and adolescents who may feel different from their peers or unable to participate in activities they enjoy.

5. Heart Palpitations and Cardiovascular Symptoms

In moderate to severe cases, the depressed sternum can compress the heart, displacing it to the left side of the chest. This compression and displacement can lead to various cardiovascular symptoms.

Common cardiac symptoms include:

• Palpitations: Awareness of the heartbeat, which may feel rapid, pounding, or irregular
• Chest fluttering: Sensation of the heart “skipping beats” or fluttering
• Increased heart rate: Tachycardia, especially during mild exertion
• Mitral valve prolapse: Some patients develop this heart valve condition, though the connection is not fully understood

While these cardiovascular symptoms can be concerning, they are usually not dangerous. However, in severe cases, the cardiac compression can potentially affect heart function, particularly during strenuous activity. Cardiac evaluation, including echocardiography, may be recommended to assess any impact on heart structure and function.

6. Postural Abnormalities

Many individuals with pectus excavatum develop compensatory postural changes in an attempt to minimize the appearance of their chest depression or to reduce discomfort.

Common postural abnormalities include:

• Rounded shoulders: Forward shoulder rotation that can make the chest depression appear less noticeable
• Forward head posture: The head positioned forward relative to the shoulders
• Kyphosis: Excessive forward curvature of the upper back
• Scoliosis: Lateral curvature of the spine, which occurs in some patients with pectus excavatum
• Hunched stance: Overall slouched appearance when standing or sitting

These postural changes can lead to additional musculoskeletal problems, including back pain, neck pain, and muscle tension. The altered posture may also contribute to reduced lung capacity and breathing efficiency, creating a cycle of worsening symptoms.

Physical therapy and posture correction exercises can help address these issues, though they do not correct the underlying chest wall deformity.

7. Psychological and Emotional Symptoms

The psychological impact of pectus excavatum should not be underestimated. The visible chest deformity can significantly affect self-esteem, body image, and mental health, particularly during adolescence and young adulthood.

Psychological symptoms commonly associated with pectus excavatum include:

• Body image concerns: Negative perception of one’s physical appearance
• Social anxiety: Fear of social situations where the chest may be visible, such as swimming or changing in locker rooms
• Depression: Persistent feelings of sadness or hopelessness related to the condition
• Social withdrawal: Avoiding activities or situations that might expose the chest deformity
• Low self-esteem: Reduced confidence and negative self-perception
• Clothing choices: Wearing baggy or loose clothing to hide the chest appearance

Studies have shown that individuals with pectus excavatum often report lower quality of life scores related to psychosocial functioning. The emotional impact can be just as significant as the physical symptoms, affecting relationships, academic or work performance, and overall life satisfaction.

Addressing these psychological concerns is an important component of comprehensive care for pectus excavatum. Many patients benefit from psychological support or counseling, particularly when considering treatment options.

Main Causes of Pectus Excavatum

The exact cause of pectus excavatum is not completely understood, but research has identified several contributing factors:

Genetic Factors: Pectus excavatum tends to run in families, suggesting a genetic component. Studies indicate that approximately 25-40% of individuals with the condition have a family history of chest wall deformities. Specific genetic mutations affecting cartilage and connective tissue development may play a role.

Abnormal Cartilage Growth: The primary mechanism involves excessive or abnormal growth of the cartilage connecting the ribs to the sternum. This overgrowth pushes the sternum inward, creating the characteristic depression. The reason for this abnormal cartilage development remains unclear.

Connective Tissue Disorders: Pectus excavatum occurs more frequently in individuals with connective tissue disorders such as Marfan syndrome, Ehlers-Danlos syndrome, and Poland syndrome. These conditions affect the structural proteins in the body, potentially contributing to chest wall abnormalities.

Rickets and Nutritional Deficiencies: In rare cases, severe vitamin D deficiency and rickets during childhood can contribute to chest wall deformities, though this is much less common in developed countries with adequate nutrition.

Congenital Development: The condition typically develops during fetal development or becomes apparent during childhood growth. While present from birth, the depression may not be noticeable until rapid growth periods make it more pronounced.

Gender Predisposition: Males are approximately 3-4 times more likely to develop pectus excavatum than females, though the reason for this gender difference is not fully understood.

Frequently Asked Questions About Pectus Excavatum

Does pectus excavatum get worse with age?

The condition often becomes more noticeable during adolescent growth spurts but typically stabilizes after skeletal maturity is reached in the late teens or early twenties. However, the symptoms may become more apparent with aging due to changes in posture and respiratory function.

Can pectus excavatum cause heart problems?

In severe cases, the depressed sternum can compress and displace the heart, potentially affecting cardiac function. Most individuals do not experience serious heart problems, but cardiac evaluation is recommended for moderate to severe cases. Some patients may develop mitral valve prolapse or experience palpitations.

Is pectus excavatum painful?

Many individuals with pectus excavatum do not experience pain, particularly in mild cases. However, some patients report chest pain, discomfort, or tenderness around the sternum and rib cage. The pain may worsen with physical activity or certain positions.

Can exercise improve pectus excavatum?

Exercise and physical therapy cannot correct the chest wall deformity itself, but they can strengthen chest muscles, improve posture, and potentially reduce the visual appearance of the depression. Regular exercise is generally encouraged and can improve overall cardiovascular fitness despite the condition.

At what age is pectus excavatum diagnosed?

While the condition is present from birth or early childhood, it may not be diagnosed until later in childhood or adolescence when the depression becomes more pronounced. Some mild cases may not be identified until adulthood. Early diagnosis allows for better monitoring and management of symptoms.

Can pectus excavatum affect breathing permanently?

The impact on breathing varies depending on severity. Mild cases typically do not cause significant respiratory limitation. Moderate to severe cases can reduce lung capacity and cause breathing difficulties, particularly during exercise. Without intervention, severe cases may lead to persistent respiratory limitations.

Is pectus excavatum associated with other health conditions?

Yes, pectus excavatum is more common in individuals with certain connective tissue disorders, scoliosis, and Marfan syndrome. It may also occur alongside other chest wall deformities. A comprehensive medical evaluation can identify any associated conditions that may require management.

Should I see a doctor if I suspect pectus excavatum?

Yes, if you or your child has a visible chest depression or experiences symptoms such as shortness of breath, chest pain, or exercise intolerance, consult a healthcare provider. A thorough evaluation can assess the severity of the condition and determine whether monitoring or intervention is appropriate. Early evaluation is particularly important for growing children and adolescents.

References:

• Mayo Clinic – Pectus Excavatum
• Children’s Hospital of Philadelphia – Pectus Excavatum
• MedlinePlus – Pectus Excavatum
• Johns Hopkins Medicine – Pectus Excavatum
• National Center for Biotechnology Information – Pectus Excavatum