chest pigeon
Pigeon chest (pectus carinatum) is caused by an abnormal development of cartilage connecting the ribs.

Pigeon chest (pectus carinatum) is the second most common chest abnormality seen in children. The breastbone, also known as the sternum, protrudes outward and shapes the chest to a bird-like appearance, hence the name pigeon chest.

The exact cause of this condition is unknown, but it is believed to result from disorders of the cartilage (a type of connective tissue) that connects the ribs to the breastbone. This cartilage may grow to push the breastbone forward. In some cases, only one side of the breastbone protrudes out, whereas, in some, it occurs on both sides.

Pigeon chest may be associated with rare genetic disorders, such as Marfan and Noonan syndromes. Sometimes, the condition runs in families.

Some people may develop a pigeon chest following open-heart surgery.

Potential causes of pectus carinatum

  • Osteogenesis imperfecta (brittle bone disease), where the bones are very fragile and easily prone to fractures
  • Down syndrome, a genetic disorder caused by the presence of an extra chromosome 21, causes developmental and intellectual delays
  • Edward’s syndrome, a genetic disorder caused by the presence of a part or complete extra chromosome 18 that causes severe developmental delays
  • Coffin-Lowry syndrome, a rare genetic disorder characterized by skeletal abnormalities, intellectual developmental delays, short stature, and hypotonia (low muscle tone)
  • Morquio syndrome, a disease characterized by abnormal bone and cartilage growth, development, form of integrity, resulting in dwarfism
  • Homocystinuria, an inherited disorder where the body cannot process certain amino acids from the dietary protein that is essential to build tissues

What are the symptoms and complications of pigeon chest?

Pigeon chest affects four times as many young men than women, and the condition worsens with age. Although the condition may be present at birth, usually, it appears in people who are 11 years or older and is more evident after a growth spurt.

The chest wall encloses and protects major organs such as the heart and lungs. Chest wall deformities may compromise lung and heart functions due to improper space in the chest cavity.

Symptoms of pigeon chest may include:

  • Shortness of breath, especially with strenuous physical activity
  • Chest wall becomes rigid and decreases the expansion of the lungs, leading to the following:
  • Complications of the heart include:
    • Chest pain
    • Tachycardia (increased heart rate)
    • Structural abnormalities of the major blood vessels and heart valves
  • Feeling tired and weak
  • Tenderness and pain in the affected area
  • Arthritis
  • Visual impairment
  • Hearing impairment
  • Scoliosis

How is pigeon chest diagnosed?

A physical examination by a doctor may help in primary diagnosis. The doctor may perform a chest X-ray to confirm the diagnosis and identify the extent of the deformity.

Based on the symptoms, the doctor may conduct further investigations to check for the functionality of the lungs and heart.

In more critical situations, the doctor will perform computed tomography or magnetic resonance imaging scans. If they consider surgery as a therapeutic option, these imaging tests can aid in the planning of the procedure.

Moreover, the doctor may perform other tests for related conditions such as Marfan syndrome, scoliosis, or congenital heart diseases.

What are the treatment options for pigeon chest?

Medical treatment may not be necessary in mild cases of pigeon chest. However, it is corrected to improve the cosmetic look that boosts self-esteem and improves the quality of life. Medical intervention is not done in children younger than 10 years.

Treatment options for pigeon chest may include:

Orthotic treatment

Doctors perform orthotic treatment in children with moderate to severe pigeon chest.

  • A special customized or universal chest compression brace is tied around the child’s chest to correct the shape.
  • This brace puts slight pressure on the child’s chest and flattens it by changing the shape and position of the sternum over a period.
  • The child must wear the brace every day for a couple of years depending on the severity of the condition.
    • The child doesn't need to have the brace on for the whole day. 
    • However, to get good results, they should wear the brace for longer hours each day.
  • The child may wear the chest brace only until they reach puberty.

Surgery

Surgeons perform surgery in severe cases of pigeon chest where the chest brace is found to be ineffective or the child had passed puberty.

  • Surgeons remove the abnormal cartilage and reposition the breastbone within the chest, which is called the Ravitch procedure.
    • They may break the breastbone to correctly reposition it.
  • Some patients may require a metal chest bar that is connected to the ribs and put across the interior of the chest.

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Medically Reviewed on 10/20/2021
References
Pectus Carinatum: https://www.ncbi.nlm.nih.gov/books/NBK541121/

Pectus Carinatum: https://www.childrenshospital.org/conditions-and-treatments/conditions/p/pectus-carinatum

Pectus Carinatum (Pigeon Chest): https://www.luriechildrens.org/en/specialties-conditions/pectus-carinatum/