Pigeon chest

Pigeon chest (pectus carinatum) is a condition in which the breastbone and rib cage are pushed forward by excessive growth of the costal cartilage. This creates a bump in the middle of the chest that resembles the chest of a bird such as a chicken. This condition can be treated with a brace or surgery.

What is a pigeon chest?

A pigeon chest develops because the costal cartilage alongside the breastbone grows too fast. This pushes the breastbone forward. A pigeon chest is almost always present at birth, but often worsens during a period of rapid growth, such as a growth spurt. The pigeon chest can occur high or low on the chest and on one or both sides of the rib cage.

Why the cartilage in some people grows too much is not known. In some cases, this seems to develop due to the use of medications, lung diseases, or chest surgeries. Heredity and the presence of other conditions, such as scoliosis, heart defects, and connective tissue disease, also play a role.

A pigeon chest occurs in about 1 in 1600 people and is more common in boys than in girls. This is less common than funnel chest, in which the rib cage grows inward.

Symptoms

Symptoms as a result of a pigeon chest vary from mild to severe. In mild cases, the bump (also called a protrusion) can be small and cause little to no symptoms. In people with a severe pigeon chest, the protrusion is clearly visible. This can lead to various problems, such as:

• Feelings of discomfort or embarrassment about appearance.
• Difficulty finding well-fitting clothing.
• Breathing problems, especially during exertion.
• Chest pain, particularly during prolonged activity.
• Reduced physical performance and endurance.

Treatment

Treatment of a pigeon chest is in many cases not immediately necessary. If there are severe physical or psychological symptoms, there are several treatment options. Depending on the severity of the symptoms, the patient, together with the surgeon, chooses a conservative or surgical treatment.

• Conservative treatment. Wearing a custom-made brace (support band). This gradually pushes the protrusion back so that it slowly decreases. In addition, there are exercises to improve the muscle strength and flexibility of the chest.
• Surgical treatment. The rapidly growing cartilage is removed and the breastbone is moved backward (Ravitch operation). Another method is the Abramson operation, in which the surgeon places a metal bar in the chest that pushes the protrusion back. 2.5 to 3 years later, the bar is removed again.