Pectus Excavatum
Pectus excavatum (PEX) is the most common chest wall malformation, in which the sternum and ribs cave inward, giving the chest a sunken appearance. Pectus excavatum, or “funnel chest,” occurs in one out of five hundred children, and is more common in boys than in girls. Despite the prevalence of this condition, not much is known about the causes of PEX. Recent research suggests there may be a genetic factor to this disease, with around 40% of patients with PEX having a family history of the condition. It has also been suggested that imbalanced overgrowth of the ribs and the sternum may contribute to PEX.
PEX is often detected within the first year of life, and progresses throughout development in childhood. Oftentimes, CT scans or MRIs are required to visualize and diagnose the condition. To check if PEX is affecting the patient’s ability to breathe, cardiopulmonary exercise training (CPET) may be used to see how severely their ability to breathe while moving or exercising is affected. In some cases, electrocardiographic monitoring is also used to see if PEX is affecting cardiac activity. However, evaluation and treatment are very different for every patient, as well as for different degrees of severity of the condition. Symptoms of PEX vary greatly for each patient. They include chest pain, difficulty breathing, decreased tolerance for exercise, fatigue, tachycardia, and palpitations. PEX may also result in recurrent respiratory tract infections, and syncopal or presyncopal episodes. It is also important to consider the psychological issues that come with having an altered body image, particularly in teens and young adults.
Research suggests that children over the age of 11 with PEX have more psychological issues than their peers without the condition. Adolescent years are some of the most formative periods of development, when people often begin to experience social worry and difficulties with their self-esteem. Having PEX can not only make young adults uncomfortable with taking their shirts off, but also have long-lasting, detrimental effects on self-image and confidence. As such, many physicians choose PEX treatment not only for the physiological symptoms, but for psychological consequences of the condition as well.
Many patients with PEX do not require surgical repair if their condition is not severe. Surgical treatment is considered for patients with severe deformity, severe impairment to breathing, and severe self-image issues. There are various surgical procedures for PEX, with the most common being the Ravitch technique and Nuss procedure. Both procedures have very low morbidity and are effective in relieving the symptoms associated with the condition. For many, performing regular aerobic exercise is sufficient.
The long-term cardiopulmonary effects of PEX are not well-understood. Dr. Dawn Jaroszewski, a cardiothoracic surgeon at the Mayo Clinic, says that early detection is important in effective treatment and recovery from the condition -- “"Repair during the teens allows the patient to complete growth and reduces the chance of recurrence,” she says. It is important to closely monitor our children’s development, and it is especially important for children who may have PEX.
References:
https://pectusexcavatumfix.com/pectus-excavatum-psychological/