Q: My grandson who is 7 years old has what I call a birdcage chest. His sternum protrudes out quite noticeably. Sometimes he complains of shortness-of-breath. His mom takes him regularly to the doctor but nothing has been found and the doctors are not concerned.
Could this bird cage be a sign of something and what specific things should we look for?
A: While often subtle and difficult to recognize, chest wall deformities include a spectrum of disorders, ranging from a sunken in appearance to one that obviously protrudes.
The sternum is the bone at the front of the rib cage. When the sternum is depressed, the condition is referred to as pectus excavatum or funnel chest,which occurs in about one out of every 500 children. This is a relatively common condition and mild cases often go unnoticed and untreated; however, with more severe signs, the deformity can cause some stress on internal organs with the lungs having less-than-optimal space in which to function properly. The heart may be unable to fill completely and the patient may have difficulties breathing and will have less energy than other children will. Milder cases can correct themselves when the child is around three years of age; moderate to severe cases, however, may grow progressively worse over time.
When the ribs protrude and take on a bird-like appearance, the condition is referred to as pectus carinatum or pigeon breast and the deformity will not cause the symptoms referred to above but could lead to scoliosis (curvature of the spine). Instead, the child may experience asymmetrical bone growth and knobby lesions may protrude from the ribs. This fairly common deformity occurs in about one out of every 1,500 children and is more common in boys than in girls but girls will have symptoms earlier than will boys. Corrective surgery is considered excellent From the tone of your note, this appears to be your grandson’s condition.
There are facilities in our country that deal with both conditions as well as other abnormalities of the chest and procedures are in place to correct them. One known as the Welsh procedure requires making an incision into the chest wall, removing the cartilage between the ribs and breastbone, and ultimately repositioning the sternum, while another inserts a bar through the chest and lifts the breastbone to its correct position. The latter treatment known as a Nuss procedure does not involve removing any cartilage. The individual undergoing the procedure is not allowed to participate in any contact sports or activities until the bar has been removed because of potential traumatic impact. When this process is performed, small incisions are made and the chest is re-shaped outwardly. The procedure is said to take two years to be totally effective and whether or not a child is a likely candidate is carefully reviewed, based on whether he or she meets the criteria for correction. Several years ago, surgery of one form or another was performed on children as young as four; however, the condition ultimately recurred. As a result, it is now more commonly done following the major growing phase, such as when the individual is in his or her teens.
Symptoms of funnel chest other than the visual include increased risk of developing pneumonia, difficulty breathing on exertion, curvature of the spine and chest pain. Symptoms for a pigeon chest include tenderness or pain over the sternum and difficulties exercising.
Diagnosis is accomplished through visual examination and from observing the child inhale and exhale and perhaps X-rays. The heart is often widened and displaced to the left and the lungs will appear to be mismatched. An EKG will detect any heart muscle stress that may be present.
If your grandson’s case is mild, no intervention may be necessary. If it is more advanced in the case of a funnel chest, surgical intervention may be recommended. Symptoms generally don’t appear following the age of about 11. I can certainly appreciate a grandparent’s concern; however, I recommend his parents take him to another pediatrician familiar with chest wall deformities for a second opinion, full examination and review of any symptoms. Collectively, they can determine if a problem exists and if any treatment is necessary. Let’s hope for the best – that you are overly concerned and nothing is wrong.
