Pectus carinatum, otherwise known as a pigeon chest, refers to a chest wall deformity in which the sternum protrudes anteriorly. It is less common than pectus excavatum.
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Epidemiology
Associations
scoliosis (common) 2
cyanotic congenital heart disease (uncommon)
familial occurrence is reported in ~25%
juvenile kyphosis (Scheuermann disease): rare 8
Clinical presentation
Patients may present with dyspnea and exercise intolerance.
Radiographic features
A pectus carinatum may be demonstrated on lateral chest radiographs or cross-sectional imaging of the chest. There are two patterns of sternal protrusion:
chondrogladiolar: protrusion of the middle and lower sternum
chondromanubrial: protrusion of the manubrium and upper sternum (less common); known as Currarino-Silverman syndrome
Treatment and prognosis
Treatment options include non-surgical external bracing, typically for adolescents 5. The average Haller index in patients requiring corrective pectus carinatum surgery is 1.8 7.
Surgical repair usually results in symptomatic improvement 3 with a variety of techniques include open Ravitch procedure, open or thoracoscopic minimal cartilage resection or the reverse Nuss procedure with success rates of ~90% (range 67-100%) 5.
History and etymology
In Latin, pectus means chest and carina is the keel of a ship 6.