Chest deformation in children. Chest in children

Chest deformation in children is a congenital or acquired change in the physiological shape, volume and size of the sternum. And there can be many reasons for this pathology. What to do and how to treat the disease? Let's look at everything in order...

The chest is a kind of musculoskeletal frame of the infant and adolescent body. Due to deformation of the sternum, children may experience various functional disruptions in the body, for example, the respiratory system, cardiovascular, and also mental. Psychological disorders can be caused by a child’s complexness due to his external defect.

Types of deformation

There are the following types of this pathology:

funnel-shaped(depressed), these changes are due to the fact that the sternum (the bone in the center of the chest) goes deeper, it is also called the “shoemaker's chest.”
keeled(rachitic) when the sternum protrudes strongly forward. It is compared to the keel of a ship. This condition is otherwise called “chicken breast”;
dysplastic chest(flat), with it a decrease in the volume of the sternum is noticed.

Causes of pathology

There are two causes of sternum deformation in children – congenital and acquired.

Congenital ones include:

genetic factors;
disruption of the formation of the skeleton (sternum, ribs, spine, shoulder blades) at the time of increase in the volume of cartilaginous and bone tissue of the child’s chest in the womb.

Acquired causes of deformity include various chronic diseases:

rickets;
tuberculosis;
scoliotic disease;
kyphosis;
osteomalacia;
chronic lung diseases;
Turner syndrome;
Down's disease;
sternum injuries.

Symptoms

Transformation of the chest manifests itself in different ways, depending on the type of deformation and the age of the child.

Pectus excavatum in children (sunken chest)

This type of pathology is observed in children much more often. The reason is insufficient development of the costal cartilages in the thoracic area (central or lower parts) and a depression appears.

There are three degrees of funnel deformation:

up to 2 cm - first degree;
from two to four cm - second degree;
more than four cm - third degree.

Deformations can have great differences: depressions can be narrow and deep, or vice versa, wide and shallow. Unilateral retraction of the sternum is often observed.

In children under 3 years of age, it is very difficult to determine the symptoms of the disease. These manifestations are most often associated with long-term, often recurring viral diseases, which can develop into pneumonia.

Children 7-10 years old and older experience difficulty breathing during and after physical activity, often experience fatigue and chest pain. They suffer from viral infections much more often than their peers.

20% of children have a lateral curvature of the spine. In severe cases, the functioning of organs such as the heart and left lung may be impaired.

Pileated chest deformity in children (protruding chest)

It occurs much less frequently in children. The main reason is excessive growth of the cartilage of the 5th and 7th ribs. It also has three degrees of severity:

up to two cm - first degree;
from two to four cm - second degree;
from four cm - third degree.

To a greater extent, the keeled chest deformity in a child has a cosmetic defect - a strong protrusion of the sternum forward. In addition, the child experiences difficulty performing physical exercises and chest pain.

Diagnostics

In order to determine the exact diagnosis, the severity of the disease and what to do next, you need to undergo a full examination by a pediatric orthopedic doctor with all clinical and instrumental methods.

Chest deformity can be diagnosed through two studies:

chest x-ray;
magnetic resonance and computed tomography;

The orthopedic doctor also prescribes diagnostics of the respiratory system, heart and blood vessels to identify the presence or absence of pathology.

How to correct the situation that has developed with a child? The famous doctor Komarovsky advises parents not to panic. Treatment for deformity depends on the type and severity of the disease. For minor chest deformation in a child, conservative treatment methods are used. For example, such as physiotherapeutic measures, wearing individual medical corsets, massage techniques, physical therapy exercises.

Activities that need to be performed in the postoperative period:

breathing exercises;
therapeutic massage;
a set of physical exercises;
taking analgesic medications for pain relief;
Regular clinical trials.

When diagnosing more severe forms of deformity, surgical intervention is used. Experienced orthopedic doctors perform surgeries to change the deformation of a child’s chest. In 90-95 percent of cases, a positive outcome of the operation is achieved.

The rehabilitation period should be as productive as possible, since the future of the baby depends on it. Therefore, it must be carried out with great benefit for the child’s body.

Chest deformity is a change in the shape of the musculoskeletal frame of the upper body. There are two main types of chest deformity in children: pectus excavatum and pectus carinatum. What is the cause of chest deformation in children, and what should parents do in case of such a diagnosis?

Types of chest deformities in children and health hazards

The health consequences associated with chest deformities in children depend on the type of deformity and its severity.

Funnel deformation Chest pain in children manifests itself in the retraction of the costal cartilages, resulting in the formation of a “funnel” or depression in the center of the chest.

There are 4 degrees of funnel chest deformity in children, depending on the depth of the “funnel”. With degree I deformation (a depression of no more than 2 cm), the child may not feel any symptoms of the disease at all. With higher degrees of deformation, the child may experience difficulty breathing, shortness of breath, and some disturbances in the functioning of internal organs due to their compression.

At keeled chest deformity in children, the sternum protrudes forward in the form of a keel, to which the ribs are attached at right angles. This deformity is often only a cosmetic defect. If the keeled deformity is severe, this can lead to problems in the functioning of the lungs, heart and other internal organs due to a violation of their relative position. In this case, it is necessary to conduct an examination and find out the features of the location and functioning of the child’s internal organs.

What can cause chest deformation in children?

Chest deformity in children most often it is a congenital disease and is formed during the prenatal period, when the child is in the mother’s womb. Scientists have not yet found an exact answer why the baby’s chest is deformed. It is only known that the likelihood of this defect increasing when:

negative heredity (the presence of this disease in the medical history of the child’s mother or father or their immediate relatives);
exposure to teratogenic factors (negative factors affecting the pregnant woman and the fetus and causing disturbances in its development without affecting hereditary structures). Such factors include the expectant mother’s experience of infectious diseases, taking antibiotics and other chemicals, contact with radiation, etc.

That is, expectant mothers need to follow standard recommendations: take care of themselves, do not contact sick people, use medications with caution, etc.

As for acquired, it can be caused by serious illnesses suffered by the child (rickets, scoliosis, pulmonary diseases, etc.) and injuries to the upper part of the body.

How is chest deformity corrected in children?

At chest deformities in children mild cases are treated conservatively, without surgery. It consists of carrying out physiotherapeutic procedures, massage, therapeutic exercises and, if necessary, wearing a special compression device for the child - orthoses and dynamic compression systems.

In more serious cases, children are prescribed surgery to correct the shape of the chest. Previously, it was believed that the younger the child being operated on, the better, since the ability of children's tissue to regenerate is much higher than that of a teenager or adult. Therefore, operations to correct the shape of the chest were performed on children in preschool age. However, now most doctors agree that early surgical correction of the chest shape can lead to abnormal growth of the ribs, recurrence of the disease and the need for repeated surgery. Therefore, surgeons recommend performing the operation no earlier than 10-12 years for boys and 12-13 years for girls.

Breathing exercises and physical therapy for chest deformation in children

The first thing you need to do when you notice a chest deformity in a child is to consult a doctor (orthopedic surgeon or more specialized specialist). If a specialist confirms that the defect does not pose a risk to the child’s health, parents can combat the deformation of the child’s chest on their own, namely, engage in breathing exercises and physical therapy with the child. These methods cannot completely correct the defect, but can slow down its development.

Breathing exercises for chest deformities in children helps correct the shape of the musculoskeletal frame, in addition, normalizes the functioning of the heart and lungs. Before doing breathing exercises with your child, you should check with your doctor to see if there are any contraindications to these exercises.

Breathing exercises

1. Holding your breath. Stand straight, feet shoulder-width apart. Take a deep breath and hold your breath for as long as possible. Then exhale sharply through your mouth. Repeat 5-10 times.

2. Upper breathing. Can be performed both standing and sitting. Inhale slowly and deeply, making sure that your stomach remains still and your chest rises. Exhale sharply through your mouth, repeat 5-10 times.

3. Expansion of the chest. Stand up straight, take a deep breath, clench your fists and extend your arms in front of you at shoulder level. With a quick movement, move your arms back and smoothly return to the starting position. Repeat several times and exhale sharply through your mouth. During the exercise, the arm muscles should be very tense.

In addition to breathing exercises, it is very useful for children with chest deformation to perform exercises to develop the pectoral muscles: push-ups, pull-ups, exercises with dumbbells and an elastic gymnastic band. Strong chest muscles will help slow down the deformation and even stop it; in addition, a developed muscular frame will visually correct a cosmetic defect and “close” the deformed chest.

Swimming is very useful for children with a deformed chest - this sport helps the development of the pectoral muscles and lungs and at the same time has very few contraindications. Volleyball, basketball and rowing are also often recommended for this disease, especially if the child shows interest in them.

Mild chest deformation in children usually does not affect their health, especially if parents take measures to correct the defect: they do breathing exercises with the child, teach him to play sports. And even if the degree of deformation is high, medicine offers effective ways to completely eliminate the defect, ranging from high-tech compression devices to modern operations with minimal intervention. We wish your children good health and good mood!

Chest deformities in children

Chest deformities in children are congenital or early acquired curvature of the sternum and the ribs that articulate with it. Chest deformities in children are manifested by a visible cosmetic defect, disturbances in the functioning of the respiratory and cardiovascular systems (shortness of breath, frequent respiratory diseases, fatigue). Diagnosis of chest deformity in children involves thoracometry, radiography (CT, MRI) of the chest organs, spine, sternum, ribs; functional studies (FVD, EchoCG, ECG). Treatment of chest deformity in children can be conservative (physical therapy, massage, wearing an external corset) or surgical.

Symptoms of chest deformities in children

Clinical manifestations of pectus excavatum vary depending on the age of the child. In infants, the depression of the sternum is usually hardly noticeable, but there is a “paradox of inhalation” - the sternum and ribs fall in when inhaling, when the child screams and cries. In younger children, the funnel becomes more noticeable; there is a tendency to frequent respiratory infections (tracheitis, bronchitis, recurrent pneumonia), and rapid fatigue when playing with peers.

The funnel chest deformity reaches its greatest severity in school-age children. Upon examination, a flattened chest with raised edges of the ribs, drooping shoulder girdles, a protruded abdomen, thoracic kyphosis, and lateral curvature of the spine are determined. The "inhalation paradox" is noticeable when breathing deeply. Children with pectus excavatum have low body weight and pale skin. Characterized by low physical endurance, shortness of breath, sweating, tachycardia, pain in the heart, arterial hypertension. Due to frequent bronchitis, children often develop bronchiectasis.

Pileated chest deformity in children is usually not accompanied by serious functional disorders, so the main manifestation of the pathology is a cosmetic defect - protrusion of the sternum forward. The degree of chest deformity in children can progress with age. When the position and shape of the heart changes, complaints of fatigue, palpitations and shortness of breath may occur.

Schoolchildren with chest deformation are aware of their physical defect and try to hide it, which can lead to secondary mental complications and require help from a child psychologist.

Poland syndrome or costomuscular defect includes a complex of defects, including the absence of pectoral muscles, brachydactyly, syndactyly, amastia or ately, deformation of the ribs, lack of axillary hair, and a decrease in the subcutaneous fat layer.

Cleft sternum is characterized by its partial (in the area of the manubrium, body, xiphoid process) or total splitting; in this case, the pericardium and the skin covering the sternum are intact.

Causes

Most often, this pathology is congenital; scientists have the following theories of its occurrence:

1. When osteochondral formations in the chest area grow unevenly, because the embryo lacks certain substances in the womb. In this case, the chest begins to form unevenly, its circumference, shape, size changes, it is quite flattened.

2. Funnel-shaped deformity is associated with congenital pathology of the diaphragm - the thoracic part lags behind in development and is shortened. The ribs are strongly inclined, because of this the muscles of the chest change their position, the front part of the diaphragm is attached to the arches of the ribs.

3. The funnel-shaped chest is deformed due to the fact that the sternum is not fully formed in utero, then dysplasia appears in the connective tissues, this affects the cardiovascular and respiratory systems, and the metabolic process is disrupted. In this case, additional signs are:

abnormalities in the shape of the eyes, they have a Mongoloid appearance;
the child's sky is high;
the skin is hyperelastic;
scoliosis, umbilical hernia, ear dysplasia develops;
The sphincter is weakened.

4. The child’s genetic predisposition to this deformity.

Modern scientists believe that the disease is provoked by an early embryonic developmental deficiency - in the first eight weeks, when the cartilaginous rib cells and sternum do not fully develop, because of this the child has a congenital pathology, the cartilage that was still in the embryo is preserved, it is fragile, soft tissue.

Treatment of chest deformities in children

Conservative treatment is prescribed for a sunken chest. In this case, treatment depends on the degree of retraction of the sternum. For grades 1 and 2, therapeutic exercises are prescribed. The main emphasis should be on the chest - push-ups, pull-ups, lifting dumbbells in a lying position, etc. The child can practice swimming, volleyball, and rowing. These sports allow you to delay the deepening process. In addition, therapeutic massage will be effective.

In complicated cases, surgical intervention is performed. The operation is performed on a child only after 6-7 years. It is at this age that the defect stops forming. In other cases, the operation is performed in the early stages.

An incision is made in the child's chest into which a magnetic plate is inserted. A belt with a magnetic plate is put on the chest area. The magnets attract each other, thanks to which sunken breasts can be corrected in 1-2 years.

If the changes are acquired, then first the child is examined for diseases that could cause deformation, and only then conservative treatment or, if necessary, surgery is performed.

Treatment of keeled chest deformity in children begins with conservative measures: exercise therapy, massage, therapeutic swimming, wearing special compression systems and children's orthoses.

Surgical correction of the keeled chest is indicated for severe cosmetic defects and progression of the degree of deformity in children over 5 years of age. Various methods of thoracoplasty include subperichondral resection of the parasternal parts of the ribs, transverse sternotomy, relocation of the xiphoid process and subsequent fixation of the sternum in its normal position by suturing it to the perichondrium and the ends of the ribs.

In case of funnel chest, conservative measures are indicated only for grade I deformity; in grades II and III, surgical treatment is necessary. The optimal period for surgical correction of funnel chest is considered to be the age of children from 12 to 15 years. In this case, fixation of the corrected position of the anterior chest can be carried out using external sutures made of metal or synthetic threads; metal fasteners; bone auto- or allografts left in the chest cavity, or without their use.

Special thoracoplasty techniques have been proposed for surgical correction of sternal clefts and costomuscular defects.

The results of chest reconstruction in children with congenital deformity are good in 80-95% of cases. Relapses occur with inadequate fixation of the sternum, more often in children with dysplastic syndromes.

Chest deformation in children refers to changes in the shape of the chest (CH), which can be either congenital or acquired. Such changes cannot be ignored, since curvature of the sternum inevitably leads to problems in the functioning of vital organs: the heart and lungs.

Moreover, as they grow older, especially entering puberty, children begin to feel complex about their appearance, which entails psychological and social problems in the form of isolation and distance from peers. Is it possible to somehow improve the situation? Today there are high-tech methods for correcting such deformities. But first, let's talk about existing species and the reasons for their appearance.

Causes of deformation

As already mentioned, an altered shape of the chest can be congenital or acquired. The congenital type is often associated with genetic factors, when “failures” occur at one of the stages of intrauterine skeletal development (formation of the sternum, shoulder blades, ribs and spine). It is known that under certain circumstances deformities are inherited. That is, if close relatives had a similar problem, there is a probability (according to various sources it ranges from 20 to 60%) that the child will inherit unusual shapes of the sternum.

One example of hereditary diseases whose symptoms include HA deformation is Marfan syndrome. This congenital pathology is characterized by damage to the musculoskeletal system, nervous and cardiovascular systems, as well as the eyes.

Often, changes in the chest are not diagnosed in a newborn and appear only as the child grows older, during periods of active growth from 5 to 8 years and at the stage of puberty, which falls at 11-15 years.

Such changes may be associated with uneven growth of the costal cartilages and sternum (when some do not keep up with the growth of others), as well as diaphragmatic pathologies (short muscles that pull the sternum inwards), underdevelopment of cartilage and connective tissue.

In newborns, no changes may be detected

There are also acquired types of deformities associated with the transfer:

skeletal diseases (rickets, tuberculosis, scoliosis);
tumor formations on the ribs (osteoma, chondroma, mediastinal tumor);
systemic diseases;
osteomyelitis of the ribs;
emphysema.

Species

The most common deformity is a funnel-shaped or keeled deformity. We will look at their features in more detail. The following types of chest deformity are less commonly found in children:

Flat chest- This is a flattened sternocostal complex with a decrease in the volume of the sternum. Typically, patients with this pathology have an asthenic body structure (thinness, narrow shoulders, tall stature, long legs and arms).
Arched sternum(Currarino-Silverman syndrome). A rare pathology that develops due to premature ossification of the sternum. Outwardly similar to a keeled deformity, when the sternum protrudes forward. Surgical treatment is carried out according to the type of sternochondroplasty (Ravich method), often with the use of osteosynthesis.
Congenital cleft sternum. An extremely dangerous and at the same time rare congenital anomaly. Its essence is that at birth a baby has a gap in the sternum, and as it grows older it increases, leaving important organs unprotected. Thus, the heart and large arteries and veins are not hidden behind the ribs, but are located subcutaneously. Even with the naked eye you can see the heart pulsation. There is only one way out: surgical correction in the early stages.
The main symptom of the syndrome is asymmetry. Most often, the pectoralis major muscle is missing on the right side, there is little subcutaneous fat, several ribs are deformed, and the nipple is missing or underdeveloped. The syndrome is also characterized by fusion of the fingers and lack of armpit hair.
Scaphoid sternum. There is a pathological oblong depression that looks like a boat or boat. Occurs as a symptom of syringomyelia.
Paralytic form. Characterized by large spaces between the ribs and a decrease in the size of the chest on the side and in the anteroposterior part. The shoulder blades and collarbone protrude. In the paralytic form, diseases of the pleura and lungs often occur.
Kyphoscoliotic type. Appears with curvature of the spine, as well as after suffering from tuberculosis.

Funnel-shaped

This type of curvature accounts for about 90% of all congenital deformities. It occurs 3 times more often in male infants than in females. In appearance, the GC seems to be pressed inward; it is also nicknamed “shoemaker’s chest.” Since the anomaly often occurs in representatives of different generations from the same family, they are inclined to believe that these are genetic changes.

The chest cavity is reduced in volume. As the pathology progresses, spinal curvatures (scoliosis, kyphosis), changes in blood pressure occur, the child suffers from colds more often than his peers, his immunity is reduced, and autonomic disorders are observed. The deformity becomes most noticeable during puberty; the sunken chest is especially noticeable when inhaling. The difference in chest circumference between inhalation and exhalation decreases by 3 times compared to the norm, and the need for surgical correction becomes obvious.

Funnel-shaped deformation has 3 degrees of severity:

Keeled

The pathology is also called “chicken breast”. Due to excessive growth of the costal cartilages, the sternum protrudes forward and resembles the shape of a keel. At birth, the deformity may be small and barely noticeable, but with age it becomes clearly visible. A child may complain that his heart hurts (as he grows up, its shape becomes like a drop), he gets tired quickly, shortness of breath and rapid heartbeat appear during physical exertion.

According to the degree of deformation, they are distinguished:

I - protrusion above the normal surface of the GC is
II - from 2 to 4 cm;
III - from 4 to 6 cm.

Signs and diagnosis

During a routine examination by a pediatrician, you can notice visible changes in the HA: its size, shape, symmetry. When listening to the heart and lungs, wheezing, heart murmurs, and tachycardia are heard. Having suspected a pathology, the pediatrician will refer the child for further in-depth examination to an orthopedic traumatologist or thoracic surgeon.

The parameters of the chest (depth, width), the degree of its change, as well as its nature are determined using thoracometry.

Diagnostics also includes X-rays in lateral and direct projections, which makes it possible to assess the severity of the deformity, how much the heart has shifted and whether there are changes in the lungs or scoliosis. However, when planning surgical treatment, the patient undergoes a CT scan. It helps to assess the degree of compression, displacement of the heart, the degree of compression of the lungs and asymmetry of deformation.

You can evaluate the functioning of the cardiovascular and respiratory systems using:

spirometry;
ECG, EchoCG;
additional consultation with a pediatric pulmonologist and cardiologist.

Conservative treatment

Therapeutic exercise

Physical exercises, swimming or physical therapy complexes by themselves, of course, do not correct bone deformities. However, they help the cardiovascular system work smoothly, promote good air exchange in the lungs and keep the body in good shape. Children's orthoses and special compression systems serve the same purpose.

This is a kind of vacuum suction cup that is installed over the deformity, which over time makes the chest more mobile and slightly pulls the funnel outward. But this method is effective only with minor changes.

Surgical treatment

Deformities of the II and III degrees cannot be treated conservatively; surgical intervention is required for further normal life. As a rule, the operation is performed in adolescence at 12-15 years.

Previously, open operations were performed using the Ravich method. They had good results, few complications, but were quite traumatic. However, now minimally invasive thoracoscopic intervention using the Nuss method has become widespread.

The essence of the operation is as follows: 2 incisions of 2-3 cm are made on both sides of the chest, an introducer is inserted through one of the incisions, it is passed into the subcutaneous space, under the muscles, inside the GC and behind the sternum, after which it is passed in front of the pericardium. This forms a channel into which a special steel or titanium plate is inserted along the tape. It is fixed by suturing it to the ribs and muscles or using special clamps.

Thus, the HA is leveled. After surgery, the patient is given strong painkillers for a week. There are retainers that must be removed after 3 years, but there are also those that are implanted for life.

In case of keeled deformity, the operation takes place in one stage, and its main task is to remove the overgrown cartilage.

Results of surgery

A cleft chest requires immediate intervention, which is why small children under one year of age are also operated on. The sternum is partially excised and then sutured along the midline. Because babies' bones are still flexible, they can "fuse" together. From one to three years of age, the sternum is also excised, and the missing fragments are filled with rib autografts. Titanium plates are installed for reliable fixation.

The prognosis for quality of life after HA reconstruction is positive. Full recovery occurs in 95% of cases. Sometimes repeated operations are required.

So, today various types of chest deformities are successfully treated. The task of parents is to notice abnormalities in the development of children in a timely manner and immediately undergo examination.

Pathologies of the skeletal system are quite common. Chest deformity in children can be congenital or acquired. In this case, the position of internal organs, in particular the heart and lungs, may change.

The rib cage is part of the baby's torso. It is formed by the following structures: ribs, sternum, spine and muscles. This bony frame limits the thoracic cavity, in which vital organs (heart, lungs, esophagus, trachea, thymus) are located. Normally, the chest is slightly compressed in the anteroposterior direction. Its main purpose is to protect internal organs.

Types of pathology

Chest deformity in a child is a pathological condition characterized by changes in the shape, size and volume of the chest due to congenital or acquired developmental defects.

This condition not only poses a threat to the baby’s health, but is also a serious cosmetic defect. With this disease, the distance between the spinal column and the sternum decreases, which can contribute to compression of organs. This pathology is diagnosed most often in boys. There are 2 types of chest deformation in children: congenital and acquired. The latter develops against the background of exposure to various harmful external and internal factors on the body.

Most often this occurs during active bone growth. As for a birth defect, it may not manifest itself for a long time. Progression is observed during a period of intensive bone (rib) growth. The incidence of chest deformity in children varies from 0.6 to 2.3%. Today, the following types of chest deformation are distinguished:

keeled (chicken);
funnel-shaped (shoemaker's chest);
flat;
curved;
Poland syndrome;
split chest.

The last three types are diagnosed very rarely.

Etiological factors

Chest deformation in children occurs for certain reasons. The acquired form of pathology is formed against the background of the following predisposing factors:

violation of the child’s posture;
scoliosis;
rickets;
bone tuberculosis;
chronic lung diseases;
neoplasms (chondromas, osteomas);
traumatic injuries;
severe burns;
connective tissue diseases.

Less common causes of acquired chest deformation in children are purulent diseases (osteomyelitis, phlegmon), mediastinal tumors, and emphysema. Sometimes the cause may be surgical operations (thoracoplasty or sternotomy). Congenital deformities can be caused by heredity or exposure to various teratogenic factors on the fetus. Violation of the formation of the thoracic frame is one of the manifestations of Marfan syndrome.

Acquired deformity

In children and adolescents, they can change due to various diseases. Most often this is associated with lung pathology. In medical practice, paralytic forms of the chest, barrel-shaped, kyphoscoliotic and scaphoid, are often encountered. The paralytic form of the chest is formed against the background of pulmonary fibrosis. At the same time, the volume of lung tissue decreases. The size of the chest decreases. In such patients, the shoulder blades stand out sharply. If the chest becomes barrel-shaped, this indicates the development of emphysema. In this case, the ribs are positioned more horizontally, and the spaces between them increase.

The kyphoscoliotic type of chest can form if a person has a tuberculosis infection or rheumatoid arthritis. The cause may also be a curvature of the spine. With a scaphoid breast, there is a depression. It forms in the middle or upper part of the sternum. The main cause of this disease is syringomyelia. Acquired chest deformity in most cases occurs between the ages of 5 to 8 and 11 to 15 years.

Pectus excavatum is associated with a congenital malformation. Its main feature is the retraction of the ribs and costal cartilages. In this case, the depth of retraction can be different. Depending on this, there are 3 degrees of severity of the pathology. A mild degree is characterized by a funnel depth of up to 2 cm. Treatment in this case can be conservative (massage, exercises). In the second degree, the size of the funnel is 3-4 cm. In this case, a displacement of the heart by 2-3 cm is observed. In the 3rd degree, the heart changes position by 3 cm, and the depression is more than 4 cm. Funnel-shaped deformity of the chest is diagnosed in 1 baby out of 300. In most cases, this defect is gradually corrected and by three years the deformity disappears. In more severe cases, the child subsequently becomes disabled.

In the general structure of congenital defects, pectus excavatum makes up about 90%. Along with changes in the shape and volume of the chest, such children experience rotation of the heart and curvature of the spine. The main cause of this disease is a violation of the formation of hyaline cartilage tissue during intrauterine development. Funnel chest is dangerous because, against the background of a decrease in the volume of the chest cavity, the following complications may develop:

increased blood pressure in the pulmonary circulation;
insufficient blood oxygen saturation;
organ dysfunction;
violation of acid-base balance;
muscle atrophy;
breathing disorder.

Such children have a risk of compression of the bronchi and changes in the location of large vessels. Symptoms of this pathology depend on the age of the child. If the child is less than 1 year old, the ribs and sternum may retract during inspiration. In preschool age, the defect contributes to frequent respiratory diseases (bronchitis, pneumonia). In this case, laryngotracheitis very often develops. Often such children exhibit stridor breathing. It differs in that there is difficulty in inhaling. In addition, muscle tension and abdominal retraction are determined.

Almost always, after 3 years, pectus excavatum leads to curvature of the spine. Thoracic kyphosis becomes more pronounced. Some children develop lateral curvatures of the spine. Symptoms are most pronounced in older children. During this period, the following symptoms may appear:

protrusion of the abdomen;
drooping shoulders;
pale skin;
weight loss;
dyspnea;
fatigue;
increased blood pressure;
signs of bronchiectasis.

Slightly less often, children are diagnosed with keeled breasts after birth. Boys suffer from this disease approximately 3 times more often than girls. In girls, this pathology progresses at a younger age. Keeled breasts are dangerous because they can lead to emphysema. All this contributes to disruption of gas exchange. Very often, keeled breasts are combined with scoliosis.

The main cause of this pathology is excessive growth of cartilage tissue in the ribs. Most often, such a violation is detected in the area of 5-7 ribs. If in the previous case there was a depression (funnel) in the chest, then in this situation the opposite is true: the sternum protrudes forward. The main manifestations from the body will be: tachycardia, changes in the configuration of the heart (it takes the shape of a drop), shortness of breath and low endurance. With age, the defect becomes more noticeable. The main method of treatment is surgical.

Diagnosis and treatment

Any experienced doctor, including the famous pediatrician Komarovsky, can detect chest deformation visually. Nevertheless, the diagnosis must be comprehensive. It includes a visual examination, interview of the child or his parents, physical examination (listening to lungs and heart sounds), examination of the oral cavity and the entire skeleton of the child. To obtain more accurate information, an x-ray examination is performed. The depth of the funnel is also measured (for a funnel-shaped cell). Additional diagnostic methods include ECG, echocardiography, cardiac MRI, and determination of the vital capacity of the lungs.

Treatment of this pathology can be conservative and surgical.

Conservative therapy is carried out for mild deformities and includes exercises, massage, swimming, and wearing special corsets.

If there is congenital pectus excavatum deformity, conservative therapy is indicated only for grade 1. Exercises, massage and other methods in this situation are carried out with the aim of preventing the progression of pathology, strengthening muscles and ligaments, preventing spinal curvature and increasing lung capacity.

If exercises (physical therapy), massage and other methods of therapy are ineffective, surgical intervention is performed. For funnel chest, surgical treatment (plasty) is preferably performed at the age of 12-15 years. Absolute indications for surgery are: severe degrees of pectus excavatum, deformities that cause mental impairment in the child, the presence of a congenital cleft chest, Poland syndrome. Contraindications to surgery include mental retardation and severe concomitant diseases of the central nervous system, heart and respiratory system. For congenital deformities, the effect of thoracoplasty is very good. Thus, chest deformation requires close attention from doctors and timely treatment.