Chest deformity in children. Thorax in children

Chest deformity 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 consider everything in order ...

The chest is a kind of musculoskeletal frame of the infant organism and adolescents. Due to the deformation of the sternum, children may experience various functional failures in the body, for example, the respiratory system, cardiovascular, and mental. Psychological disorders can be caused by a child's complexes due to their external flaw.

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 deep, it is also called the "shoemaker's chest".
keeled(rachitic) when the sternum strongly protrudes forward. It is compared to the keel of a ship. This condition is otherwise referred to as "chicken breast";
dysplastic chest(flat), with it a decrease in the volume of the sternum is noticed.

Causes of the appearance of pathology

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

Congenital include:

genetic factors;
violation of the formation of the skeleton (sternum, ribs, spine, shoulder blades) at the time of an increase in the volume of cartilage and bone tissue of the breast of a child 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;
chest injury.

Symptoms

The transformation of the chest manifests itself in different ways, it is affected by the type of deformation and the age of the child.

Funnel chest deformity in children (sunken chest)

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

There are three degrees of funnel deformity:

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

Deformations can be very different from each other: depressions are narrow and deep, and vice versa, they can be wide and shallow. One-sided retraction of the sternum is often observed.

In children under the age of 3 years, it is very difficult to identify the symptoms of the disease. These manifestations are most often associated with prolonged, often recurring viral diseases that can progress to pneumonia.

Children 7-10 years of age and older have difficulty breathing during and after physical exertion, often experience overwork, chest pain. They are much more likely to get viral infections than their peers.

In 20% of children, lateral curvature of the spine is observed. In severe cases, organs such as the heart and left lung may be affected.

Keeled deformity of the chest in children (protruding chest)

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

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

To a greater extent, the keeled deformity of the chest in a child has a cosmetic defect - a strong protrusion of the sternum forward. In addition, the child has difficulty exercising, 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 orthopedist with all clinical and instrumental methods.

Diagnosis of chest deformity can be done by two studies:

chest x-ray;
magnetic resonance and computed tomography;

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

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

Activities to be performed in the postoperative period:

breathing exercises;
massotherapy;
a set of physical exercises;
taking analgesic drugs for the purpose of pain relief;
regular clinical trials.

When diagnosing more severe forms of deformity, surgical intervention is used. Experienced orthopedic surgeons perform operations to change the deformity of the 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 his future 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 skeleton of the upper body. There are two main types of chest deformity in children: funnel-shaped and keeled. What is the cause of chest deformity 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 deformity in children depend on the type of deformity and its degree.

funnel deformity chest in children manifests itself in the sinking 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 I degree of deformation (deepening no more than 2 cm), the child may not feel any symptoms of the disease at all. At higher degrees of deformity, the child may experience difficulty in 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 a right angle. This deformity is often only a cosmetic defect. If the keeled deformity is pronounced, 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 internal organs of the child.

What can cause chest deformity in children?

Chest deformity in children most often it is a congenital disease and is formed even in the prenatal period, when the child is in the mother's womb. Scientists have not yet found the exact answer why the baby's chest is deformed. It is only known that the probability of the manifestation of this defect increases with:

negative heredity (the presence of this disease in the anamnesis of the mother or father of the child or their immediate family);
exposure to teratogenic factors (negative factors that affect the pregnant woman and the fetus and cause disturbances in its development, without affecting hereditary structures). These factors include transfer by the expectant mother infectious diseases, taking antibiotics and other chemicals, exposure to radiation, etc.

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

As for the acquired one, 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 mildly conservative treatment is carried out, without surgical intervention. It consists in carrying out physiotherapeutic procedures, massage, therapeutic exercises and, if necessary, in wearing a child with special squeezing devices - 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 operated child, the better, since the ability of children's tissues to regenerate is much higher than that of a teenager or an adult. Therefore, operations to correct the shape of the chest were performed on babies as early as preschool age. However, now most doctors agree that early surgical correction of the shape of the chest can lead to abnormal growth of the ribs, recurrence of the disease and the need for a second operation. Therefore, surgeons recommend performing the operation no earlier than 10-12 years for boys and 12-13 years for girls.

Respiratory gymnastics and physiotherapy exercises for chest deformity in children

The first thing to do if a chest deformity is found in a child is to consult a doctor (orthopedic surgeon or a narrower specialist). If the specialist confirms that the defect does not pose a risk to the health of the child, parents can deal with the deformity of the child's chest on their own, namely, do breathing exercises and physiotherapy exercises with the child. These methods cannot completely correct the defect, but they can slow down its development.

Breathing exercises for chest deformities in children helps to correct the shape of the musculoskeletal frame, in addition, normalizes the work of the heart and lungs. Before practicing breathing exercises with a child, you should check with the doctor - are there 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 the stomach remains still and the chest rises. Exhale sharply through the 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, take your hands back and smoothly return to the starting position. Repeat several times and exhale sharply through your mouth. During the exercise, the muscles of the hands should be very tense.

In addition to breathing exercises, it is very useful for children with chest deformity to perform exercises for the development of pectoral muscles: push-ups, pull-ups, exercises with dumbbells and an elastic gymnastic tape. Strong muscles of the chest will help slow down the deformation and even stop it, in addition, the developed muscular frame will visually correct the cosmetic defect, “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 deformity 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, disorders 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, spine, sternum, ribs; functional studies (RF, EchoCG, ECG). Treatment of chest deformity in children can be conservative (exercise therapy, massage, wearing an external corset) or surgical.

Symptoms of chest deformities in children

The clinical manifestations of pectus excavatum vary with the age of the child. In infants, the depression of the sternum is usually hardly noticeable, however, there is a "paradox of inspiration" - the sternum and ribs sink down when inhaling, when the child screams and cries. In younger children, the funnel becomes more prominent; there is a tendency to frequent respiratory infections (tracheitis, bronchitis, recurrent pneumonia), fatigue in games with peers.

Funnel chest deformity reaches its greatest severity in children of school age. On examination, a flattened chest with raised edges of the ribs, lowered shoulder girdle, protruding abdomen, thoracic kyphosis, and lateral curvature of the spine are determined. The "paradox of inhalation" is noticeable with deep breathing. 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.

Keeled deformity of the chest 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 may 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 deformity are aware of their physical handicap, try to hide it, which can lead to secondary mental layers and require help from a child psychologist.

Poland's syndrome or rib-muscular defect includes a complex of defects, including the absence of pectoral muscles, brachydactyly, syndactyly, amastia or atelius, deformity of the ribs, lack of axillary hair growth, and a decrease in the subcutaneous fat layer.

The cleft of the sternum is characterized by its partial (in the area of the handle, body, xiphoid process) or total splitting; at the same time, the pericardium and the skin covering the sternum are intact.

Causes

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

1. When bone and cartilage formations grow unevenly in the chest area, because the embryo lacks certain substances in the womb. At the same time, the chest begins to form unevenly, its circumference, shape, size change, it is quite flattened.

2. Funnel-shaped deformity is associated with a 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 anterior 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 incompletely formed in utero, then dysplasia appears in the connective tissues, this affects the cardiovascular, respiratory system, the metabolic process is disturbed. The additional features are:

violations in the cuts of the eyes, they have a Mongoloid appearance;
the child's sky is high;
the skin is hyperelastic;
scoliosis, umbilical hernia, ear dysplasia develop;
weakened sphincter.

4. Genetic predisposition of the child to this deformation.

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 the 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 sunken chest. In this case, treatment depends on the degree of retraction of the sternum. At 1 and 2 degrees, therapeutic exercises are prescribed. The main emphasis should be placed on the chest - push-ups, pull-ups, spread dumbbells in the prone position, etc. The child can go in for swimming, volleyball, rowing. These sports allow you to delay the deepening process. In addition, therapeutic massage will be effective.

In a complicated case, surgical intervention is performed. The operation is performed on the child only after 6-7 years. It is at this age that the defect ceases to form. In other cases, the operation is done early.

An incision is made in the child's chest, where a magnetic plate is inserted. A belt with a magnetic plate is put on the chest area. Magnets are attracted to each other, so sunken breasts can be corrected in 1-2 years.

If the changes are acquired, then the child is first examined for diseases that could cause deformity, 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 a pronounced cosmetic defect and progression of the degree of deformity in children older than 5 years. Various methods of thoracoplasty include subperichondral resection of the parasternal parts of the ribs, transverse sternotomy, repositioning of the xiphoid process, and subsequent fixation of the sternum in its normal position by suturing it to the perichondrium and ends of the ribs.

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

Special thoracoplasty techniques have been proposed for the surgical correction of cleft sternum and costo-muscular defects.

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

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

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

Causes of deformation

As already mentioned, the 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 development of the skeleton (formation of the sternum, shoulder blades, ribs and spine). It is known that under certain circumstances, deformations are inherited. That is, if the next of kin had a similar problem, there is a possibility (according to various sources, it ranges from 20 to 60%) that the child inherits unusual forms of the sternum.

One example of a hereditary disease, the symptoms of which include deformation of the HA, is Marfan's syndrome. This congenital pathology is characterized by lesions of 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 up, during periods of active growth from 5 to 8 years and at the stage of puberty, which falls on 11-15 years.

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

Newborns may not show any changes

There are also acquired types of deformation 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.

Kinds

The most common is a funnel-shaped or keeled deformity. We will consider their features in more detail. Chest deformity is less commonly found in children of the following types:

Flat chest- this is a flattened sternocostal complex with a decrease in the volume of the sternum. Usually, patients with such a 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, it looks like a keeled deformity, when the sternum bulges forward. Surgical treatment is carried out according to the type of sternochondroplasty (Ravich's 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 a baby has a gap in the sternum at birth, and as it grows older, it increases, leaving important organs unprotected. So, the heart and large arteries and veins do not hide behind the ribs, but are located subcutaneously. Even with the naked eye, you can see the heartbeat. 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 absent on the right, there is little subcutaneous fatty tissue, several ribs are deformed, the nipple is absent or underdeveloped. The syndrome is also characterized by fusion of the fingers and lack of armpit hair.
Scaphoid sternum. There is a pathological elongated depression, outwardly resembling a boat or boat. Occurs as a symptom of syringomyelia.
paralytic form. Large spaces between the ribs and a decrease in the size of the chest from the side and in the anteroposterior part are characteristic. 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 the transfer of tuberculosis.

funnel-shaped

This type of curvature accounts for about 90% of all congenital deformities. In male infants, it occurs 3 times more often than in females. In appearance, the GK, as it were, was pressed inward, it was also called the "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. With the progression of the pathology, curvature of the spine (scoliosis, kyphosis), changes in blood pressure occur, the child suffers from colds more often than his peers, his immunity is reduced, vegetative disorders are observed. The deformation becomes most noticeable at puberty, the sunken chest is especially evident during inspiration. The difference in chest circumference between inhalation and exhalation is reduced by 3 times compared to the norm, and the need for surgical correction becomes obvious.

Funnel-shaped deformity has 3 degrees of severity:

Keeled

Pathology is also called "chicken breast". Due to the overgrowth of the costal cartilage, the sternum protrudes forward and resembles the shape of a keel. At birth, the deformity may be small, barely noticeable, but with age it becomes clearly visible. The child may complain that his heart hurts (as he grows up, his shape becomes like a drop), he quickly gets tired, shortness of breath, palpitations appear during physical exertion.

According to the degree of deformation, there are:

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

Signs and Diagnosis

At 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, tachycardia are heard. Suspecting 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 the nature are determined using thoracometry.

Diagnosis also includes radiography in lateral and direct projection, which allows you to assess the severity of the deformation, how much the heart has shifted and whether there are changes in the lungs, scoliosis. However, when planning surgical treatment, the patient is given a CT scan. It helps to assess the degree of compression, displacement of the heart, the degree of compression of the lungs and the asymmetry of the deformity.

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

spirometry;
ECG, echocardiography;
additional consultation of a pediatric pulmonologist and a cardiologist.

Conservative treatment

Physiotherapy

By themselves, physical exercises, swimming lessons or exercise therapy complexes, of course, do not correct bone deformities. However, they help the cardiovascular system to 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, which is installed over the deformation, which over time makes the chest more mobile and slightly pulls the funnel out. But this method is effective only with minor changes.

Surgery

Deformities II and III degree are not treated conservatively, for further normal life, surgical intervention is required. As a rule, the operation is done 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, minimally invasive thoracoscopic intervention using the Nass method has now 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 carried out into the subcutaneous space, under the muscles, inside the GC and behind the sternum, after which it is carried out 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 to the ribs and muscles or using special fixators.

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

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

The results of surgery

Cleft chest requires immediate intervention, and therefore small children up to a year old are also operated on. The sternum is partially excised, then sutured along the midline. Since the bones in babies are still flexible, they can "regrow". From a year to 3 years, the sternum is also excised, and the missing fragments are filled with rib autografts. For reliable fixation, titanium plates are installed.

The forecasts for the quality of life after the reconstruction of the HA are positive. Complete 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 anomalies in the development of children in time and be examined immediately.

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

Types of pathology

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

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

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 the period of intensive growth of bones (ribs). The incidence of chest deformity in children varies from 0.6 to 2.3%. Today, the following types of chest deformity are distinguished:

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

The last three types are diagnosed very rarely.

Etiological factors

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

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

Less often, the cause of acquired chest deformity in children is purulent diseases (osteomyelitis, phlegmon), mediastinal tumors, emphysema. Sometimes the cause may be surgical operations (thoracoplasty or sternotomy). Congenital curvature may be due to heredity or exposure to the fetus of various teratogenic factors. Violation of the formation of the chest frame is one of the manifestations of Marfan's syndrome.

Acquired deformity

In children and adolescents, they can change with various diseases. Most often it is associated with pathology of the lungs. In medical practice, there is often a paralytic form of the chest, barrel-shaped, kyphoscoliotic and navicular. 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 is reduced. In such patients, the shoulder blades stand out sharply. If the chest becomes like a barrel, this indicates the development of emphysema. In this case, the ribs are located more horizontally, and the gaps between them increase.

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

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

In the general structure of congenital malformations, the funnel chest is about 90%. Along with a change 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 fetal 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 saturation of blood with oxygen;
dysfunction of organs;
violation of acid-base balance;
amyotrophy;
respiratory failure.

In such children, there is a risk of squeezing the bronchi and changes in the location of large vessels. The 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 inhalation. At preschool age, the defect contributes to frequent respiratory diseases (bronchitis, pneumonia). In this case, laryngotracheitis develops very often. Quite often at such children stridorny breath comes to light. It differs in that there is difficulty in breathing. In addition, muscle tension, retraction of the abdomen is determined.

Almost always after 3 years, the funnel chest leads to a curvature of the spine. Thoracic kyphosis becomes more pronounced. Some children develop lateral curvature 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;
fast fatiguability;
increased blood pressure;
signs of bronchiectasis.

A little less often, keeled breasts are diagnosed in children after birth. Boys suffer from this disease about 3 times more often than girls. In girls, this pathology progresses at a younger age. The keeled chest is dangerous because it can lead to emphysema. All this contributes to the violation of gas exchange. Very often, the keeled chest is combined with scoliosis.

The main cause of this pathology is the excessive growth of cartilage tissue in the area of the ribs. Most often, such a violation is detected in the region of 5-7 ribs. If in the previous case there was a recess (funnel) in the chest, then in this situation the opposite is true: the sternum protrudes forward. The main manifestations on the part of the body will be: tachycardia, a change in the configuration of the heart (it takes the form 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 well-known pediatrician Komarovsky, can visually detect chest deformity. Nevertheless, the diagnosis must be comprehensive. It includes a visual examination, a questioning of the child or his parents, a physical examination (listening to lung and heart murmurs), an examination of the oral cavity and the entire skeleton of the child. For more accurate information, an X-ray examination is performed. The depth of the funnel is also measured (with a funnel cell). Additional diagnostic methods include ECG, EchoCG, MRI of the heart, determination of lung capacity.

Treatment of this pathology can be conservative and surgical.

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

If there is a congenital pectus excavatum, conservative therapy is indicated only at grade 1. Exercises, massage and other methods in this situation are carried out in order to prevent the progression of pathology, strengthen muscles and ligaments, prevent spinal curvature and increase lung capacity.

If exercise (exercise therapy), massage and other therapies are ineffective, surgical intervention is performed. With a funnel chest, surgical treatment (plastic surgery) is preferably carried out at the age of 12-15 years. Absolute indications for surgery are: severe funnel chest, deformities that caused a mental disorder in a child, the presence of congenital cleft breast, Poland's syndrome. Contraindications to surgery include mental retardation and severe concomitant diseases of the central nervous system, heart and respiratory system. With congenital deformity, the effect of thoracoplasty is very good. Thus, chest deformity requires close attention of doctors and timely treatment.