What is Pectus Carinatum?

What is Pectus Carinatum?

Pectus carinatum is a deformity of the chest wall that causes the breastbone to protrude outward rather than flat against the chest wall. It’s sometimes referred to as a keel chest or a pigeon chest.

Cause: The cartilaginous ribs that join the bony ribs to the sternum normally grows flat along the chest wall as it develops. This cartilage develops abnormally in cases of pectus carinatum, producing uneven development in the places where the ribs attach to the sternum. The chest wall appears to be extending outward as a result of this.

Incidence: Most of the time, pectus carinatum becomes more prominent in children as they enter puberty. It’s possible that it won’t be detected until they’re in their adolescent years. This abnormality affects around 1 in every 350-450 children and this condition affects four times as many males as females, this has been considered as the second most common chest abnormality seen in children.

Risk Factors, Symptoms, Diagnosis and Treatment of Pectus Carinatum

Risk Factor: Pectus carinatum is more likely in those who have a family history of this condition or other chest wall abnormalities. Marfan’s syndrome, for example, is a connective tissue ailment that increases the likelihood of developing this deformity. It can also be associated with congenital cardiac disease and premature breastbone fusion when discovered in infancy. Caucasian people are also significantly more likely than persons of other races to have pectus carinatum. Once an individual with pectus carinatum stops growing, their chest will no longer protrude. 

Symptoms: Oftentimes, the pushing of the breastbone outward is the only symptom that a person experiences. Though some may report other symptoms, such as:

  • Discomfort in their chest as their chest continues to protrude 
  • Fatigue 

Diagnosis: Physical examination is a common way to identify pectus carinatum, but you may also require a chest X-ray to rule out this condition. In some circumstances, a CT or MRI scan may be used as well.


  1. Bracing: For most cases, treatment may not be necessary. The use of a brace is the most typical treatment option for mild to severe instances. For at least six months, you’ll need to wear the brace for at least eight hours a day. This constant pressure causes the cartilage to gradually reshape. On a case-by-case basis, a doctor determines the amount of pressure that will be necessary to address the problem while using a brace. Within a few months, you should be able to observe results.
  2. Surgery: The cartilage that pushes the breastbone outward is frequently removed during surgical therapy for pectus carinatum. An incision is made in the center of the chest to do this. Later, struts are inserted across the chest to support the front of the breastbone and then removed via surgery to support the front of the breastbone. Dr. LoSasso performs this surgery at the Center of Excellence for Pectus. The surgery is called the Ravitch procedure and reserved for adult pectus carinatum patients who will no longer respond appropriately to bracing. 
  3. Exercise: People have been experimenting with exercise as a possible therapy for pectus carinatum in recent years. The muscles around the protruding region are targeted in these workouts, which are meant to reduce the appearance of the chest cavity bulging outward. This solution hasn’t been well researched, and since pectus carinatum is a skeletal issue, exercises are generally not effective in treating this issue. 


With the use of a chest brace, children with pectus carinatum have a good chance of having a normalized chest. The ribs’ external appearance may frequently be reversed with the help of braces. In some situations, surgery may be needed to correct the deformity, especially in the adult population.

Interested in getting an evaluation scheduled? Dr. Barry E. LoSasso is a renowned, highly-regarded board-certified pediatric surgeon from the Center of Excellence for Pectus. Please schedule a virtual or online consultation to learn more at (201) 225-9440 or https://nussprocedure.com/contact-us/.