Pectus Excavatum

Pectus excavatum, also referred to as "sunken chest" or "funnel chest," is a depression in the chest wall, with the breastbone appearing to be caved in. The depression may be in the center of the chest or more pronounced on one side. A child can be born with pectus excavatum or develop it during the pubertal growth spurt. The pectus excavatum may become more severe or apparent during periods of rapid growth. Early evaluation by a pediatric surgeon during the prepubertal period is helpful for families to gain an understanding of what to expect as their child matures and when intervention is optimal.

Evaluation of pectus excavatum

At the Stanford Medicine Children’s Health Chest Wall Clinic, your child will meet with our team as we obtain a complete history and physical exam. We may then recommend additional diagnostic testing to best prepare your child for the most appropriate intervention that fits his/her individual needs. These diagnostic tests may include the following:

• X-Ray, MRI or CT scan of the chest
• In-office 3D imaging of the chest wall
• Cardiac echocardiogram
• Pulmonary function testing
• Allergy patch testing

Once the work-up is complete, we will review with you the best options for your child. These options are discussed below.

Treatment of pectus excavatum

Vacuum bell. We are pleased to offer this uncommon yet effective nonsurgical treatment option for mild to moderate pectus excavatum. The vacuum bell is fitted to each patient to sit comfortably on the chest by our care team. A bulb attached to the device generates negative pressure to create a vacuum, which raises the sternum over time. The vacuum bell must be applied at regular intervals, eventually up to two hours each session, twice daily. The vacuum slowly pulls up the depressed area of cartilage. It may take several months of use to reach the maximum correction of pectus excavatum.

Nuss procedure. The most commonly performed surgical treatment for pectus excavatum is the Nuss procedure. This is a minimally invasive surgical procedure. During this procedure, small incisions are made on each side of the chest to allow the surgeon to insert a metal support bar underneath the sternum to reverse the depression in the chest. Minimally invasive surgical techniques result in reduced blood loss and shorter operating times that lead to a smoother, faster recovery. Managing your child’s pain is very important to us. That’s why we offer state-of-the-art pain control techniques, including cryoablation and others to reduce pain and recovery time after surgery.

Bar removal. The bar is generally removed between two to four years after the procedure and can be completed on an outpatient basis under general anesthesia.