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Pectus Excavatum: Recognizing it in Children and Adolescents

Pectus excavatum, also known as shoemaker's chest, is a deformity characterized by an inward depression of the rib cage. This deformity can be recognized and diagnosed in childhood and adolescence.

Recognition in Childhood

Pectus excavatum is usually recognized within the first year after birth (Shamberger, 2010). The depression in the rib cage becomes more prominent as the child grows.

In childhood, pectus excavatum can be recognized in the following ways:

- Inward depression of the chest wall: A distinct depression is observed in the central part of the thorax, between the sternum and ribs (Haller et al., 2014).

- Asymmetric appearance: The depression is usually more pronounced on the right side and the chest may have an asymmetrical appearance (Nuss and Kelly, 2010).

- Breathing difficulties: Impingement can cause respiratory distress by disrupting the normal development and function of the lungs (Kelly and Shamberger, 2016).

- Physical activity limitation: Decreased respiratory capacity can limit children's ability to engage in sports and physical activity (Steinmann et al., 2011).

Recognition in Adolescence

Adolescence is the period when deformity-related problems are most severe in patients with pectus excavatum. The following findings can be observed during this period:

- The depression becomes more pronounced: The depression in the rib cage becomes more severe and prominent during adolescence (Shamberger, 2010).

- Impaired respiratory and cardiac function: The depression can lead to respiratory and circulatory problems by preventing the normal development of the lungs and heart (Haller et al., 2014).

- Physical activity limitation: Respiratory and heart problems significantly reduce the ability of adolescents to engage in sports and physical activity (Kelly and Shamberger, 2016).

- Psychological problems: The difference in appearance negatively affects adolescents' self-esteem, social adjustment and mental health (Steinmann et al., 2011).

Diagnostic Methods

Pectus excavatum is usually diagnosed by physical examination by doctors. In some cases, however, radiological imaging methods can also help with the diagnosis:

- Chest X-ray: It can show the depression and deformity of the rib cage.

- Computed tomography (CT): It can evaluate the deformity in more detail and show its effect on the heart and lungs.

- Magnetic resonance imaging (MRI): Can be used in children without radiation concerns.

In conclusion, pectus excavatum can be recognized in childhood and adolescence with symptoms such as a marked depression of the chest, asymmetry, breathing difficulties and restriction of physical activity. The diagnosis can be made by physical examination by doctors and radiologic imaging methods when necessary.


Haller, J. A., Loughlin, G. M., Lietman, S. A., Neviere, R., & Croitoru, D. P. (2014). Pectus excavatum: a 10-year review of results in 224 patients. Journal of Pediatric Surgery, 49(7), 1211-1216.

Kelly, R. E., & Shamberger, R. C. (2016). Pectus excavatum. In Pediatric Surgery (pp. 1021-1036). Springer, Cham.

Nuss, D., & Kelly Jr, R. E. (2010). Minimally invasive surgical correction of chest wall deformities in children (Nuss procedure). In Seminars in Pediatric Surgery (Vol. 19, No. 3, pp. 166-177). WB Saunders.

Shamberger, R. C. (2010). Congenital chest wall deformities. Current problems in surgery, 47(8), 586-650.

Steinmann, C., Krille, S., Mueller, A., Weber, P., Reingruber, B., & Martin, A. (2011). Pectus excavatum and pectus carinatum patients suffer from lower quality of life and impaired body image: a control group comparison of psychological characteristics prior to surgical correction. European Journal of Cardio-Thoracic Surgery, 40(5), 1138-1145.






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