Pectus Carinatum

Introduction

It is a protrusion deformity of the chest that occurs less frequently than excavatum and consists of a spectrum of deformities with unilateral or bilateral involvement of costal cartilage and superior or inferior protrusion of the sternum. It can also exist as a mixed deformity with depression of cartilages on one side and protrusion on the opposite side with sternal rotation. The most common clinical presentation is a protrusion of the sternal body with symmetric protrusion of lower costal cartilages (chondrogladiolar). In a majority of patients, the deformity appears in late childhood or adolescence with only a third of patients presenting with this condition at birth. It is thrice as common in males than in females. 15% of children have associated scoliosis and Marfan's syndrome must be looked for in patients with severe deformity. There is no cardiopulmonary compromise demonstrable in these patients. Consideration for surgery is purely cosmetic and psychosocial.

Generally, surgery should be deferred to maturity. Operative correction involves subperichondrial resection of costal cartilages and sternal osteotomy. Complications are low and recurrences rare. Recurrence is limited to patients who have undergone a unilateral resection of costal cartilages or an inadequate resection of the deformity.