The chest wall is the structure of the chest region that protects vital organs, such as the lungs, heart, liver, and major blood vessels. The structure is composed of fat, muscle, skin, and the thoracic spine. The thoracic spine is the upper portion of the spine that supports the rib cage.
Sometimes, children are born with or develop a physical defect in the chest wall. These deformities may include:
- Pectus excavatum: Also called funnel chest, pectus excavatum is the most commonly diagnosed chest wall defect. This abnormality is characterized by a sunken breastbone, or when the middle of the chest looks like it was pushed inward.
- Pectus carinatum: Also called pigeon chest, pectus carinatum is characterized by a breastbone that protrudes or looks like it has been pushed outward.
Additionally, tumors can develop in childhood or later in life and may interfere with the normal function of various organs. Tumors can be either benign (non-cancerous) or malignant (cancerous).
Symptoms of chest wall tumors and defects
Symptoms will vary depending on the type of chest wall defect present.
Symptoms associated with funnel chest may include:
A depression in the chest
Scoliosis or an absence of the outward curvature of the upper (thoracic) spine
Colds that do not go away and may lead to pneumonia
Difficulty breathing, either when still or during exercise
Recurring, frequent chest infections
Symptoms associated with pigeon chest may include:
An outward protrusion of the chest
Tenderness in the area of the chest that is pushed outward
Difficulty exercising or playing
Chest wall tumors may cause:
A protrusion of the chest
Pain or soreness in the chest
Causes of tumors and defects
Chest wall deformities are often noticeable at birth, but can also develop in the early childhood years. The causes of deformities are currently unknown. Scientists have linked some cases of these deformities to family history. However, there are many cases where there is no family history of defects. Researchers are currently investigating the role of genetics.
Sometimes, chest wall deformities are the result of certain conditions, like:
- Jeune's syndrome: A rare genetic disorder that affects proper growth and development of the bones, resulting in a type of dwarfism. As a result, the ribs are often shorter than typical, causing the chest cavity to be smaller than normal.
- Poland syndrome: A rare genetic disorder that affects the development of the muscles on one side of the body, including major muscles in the chest region. It can oftentimes lead to the absence of the major muscle in the chest, the pectoralis muscle.
The reason for chest wall tumor development is also unknown.
What to expect at your appointment
Your doctor may prescribe imaging studies in order to understand the severity of the structural abnormality or the tumor. The results will also help your physician to understand if treatment is necessary, and, if so, which type of treatment will be most effective in returning the chest wall to a natural structure to eliminate symptoms.
Non-surgical treatments for tumors and defects
Pigeon chest can sometimes be treated using a brace that gradually decreases the protrusion of the sternum.
Certain cases of mild or moderate funnel chest can be treated using a machine called a vacuum bell. This technique uses a device that is fitted to the patient’s chest and applies negative pressure to raise the sternum slightly over a certain period of time.
Most of these tumors must be treated surgically. In some cases, radiation and/or chemotherapy may be prescribed either before or after surgery to remove the tumor.
Surgical treatment for tumors and defects and post-treatment
Recommended treatment options will depend on the patient’s diagnosis as well as the severity of symptoms presented. Surgical resection of tumors may require surgeons to remove a portion of the chest wall in order to ensure that the entire tumor is taken and to reduce the risk that it will return.
Surgical reconstruction is necessary to correct more severe physical deformations of the chest wall and may also be necessary after resection.
The most commonly performed surgical treatment for the correction of funnel chest is a minimally invasive procedure called the Nuss procedure. During this surgery, small incisions are made on either side of the chest, where a metal bar is inserted and carefully placed underneath the sternum, working to raise the bone over the next two to four years.
Recovery time after surgery will vary based on the type of surgery performed, as well as the complexity of the diagnosis.