Pectus Excavatum vs. Pectus Carinatum: An Overview (2025)

Pectus excavatum and pectus carinatum are two of the most common chest wall deformities that affect the shape and appearance of the sternum. While both conditions involve abnormal growth of the cartilage that connects the ribs to the breastbone, they present in opposite ways—one causing the chest to sink inward and the other pushing it outward.

These deformities can range from mild cosmetic concerns to more severe cases that impact breathing, posture, or heart function.

Understanding the differences between pectus excavatum and pectus carinatum is essential for recognizing symptoms, exploring treatment options, and supporting overall health and confidence.

What is the Difference Between Pectus Excavatum and Pectus Carinatum?

Pectus excavatum and pectus carinatum are chest wall deformities with opposite appearances. Pectus excavatum, often called “funnel chest,” occurs when the breastbone (sternum) sinks inward, creating a sunken chest. It is the most common chest deformity and can sometimes affect breathing or heart function in severe cases.

Pectus carinatum, or “pigeon chest,” is less common and involves the sternum protruding outward, giving the chest a raised or pointed appearance.

Both conditions usually develop during childhood and adolescence, may cause physical or psychological concerns, and can be managed with braces, physical therapy, or corrective surgery, depending on severity.

Key Differences Between Pectus Excavatum and Pectus Carinatum

These two chest wall deformities differ in shape, cause, and how common they are. While both affect the structure of the chest, their physical appearance and underlying characteristics are distinct.

Pectus Excavatum

Pectus excavatum is a condition where the breastbone (sternum) is sunken inward. This creates a concave or “caved-in” appearance of the chest. It typically develops during childhood and adolescence. The inward depression can sometimes affect lung and heart function, especially in severe cases. It is largely considered a structural deformity of the cartilage connecting the ribs to the sternum.

Treatment varies from observation to surgical correction depending on severity and symptoms. Pectus excavatum is usually more noticeable when a person is at rest or lying down.

Pectus Carinatum

Pectus carinatum causes the chest to protrude outward, giving a “pigeon chest” look. The sternum and ribs push outward instead of inward. This deformity also begins in childhood and tends to worsen during growth spurts. It rarely affects internal organs but can cause discomfort and breathing issues in some cases.

The cause is related to abnormal cartilage growth. Bracing is often recommended for mild to moderate cases, while surgery may be needed when the deformity is severe or causes symptoms.

Chest Wall Appearance

Pectus excavatum presents as a noticeable depression in the middle of the chest. The sunken area can be shallow or deep and may cause asymmetry on one side. Pectus carinatum shows as a rigid, outward projection of the sternum. The protrusion can affect just the lower part of the sternum or the entire chest front. It often causes a convex shape.

Note: Both conditions can impact posture and the shape of the rib cage, but their visual cues are opposite—one is concave, the other convex.

Prevalence Rates

Pectus excavatum is the most common chest wall deformity, occurring in about 1 in 400 to 1 in 1,000 births. It is more common in males than in females. Pectus carinatum is less common, seen in about 1 in 1,500 to 1 in 2,000 births. Like excavatum, it is more frequent in males.

Note: Both conditions can run in families, suggesting a genetic component. However, pectus excavatum is generally recognized as having a higher prevalence worldwide.

Symptoms and Clinical Presentation

Pectus excavatum and pectus carinatum present distinct physical deformities that affect the chest wall’s shape. Both conditions can influence breathing and heart function, though the degree varies. Clinical signs often guide diagnosis along with respiratory and cardiac evaluation.

Physical Signs

Pectus excavatum causes a noticeable sunken or concave depression in the sternum, often described as a “funnel chest.” The deformity can range from mild to severe, with the sternum appearing pushed inward. This indentation is typically symmetrical but can be asymmetrical in some cases.

Pectus carinatum shows a protruding, outward bulge of the sternum and adjacent ribs. The chest may look pigeon-shaped or like a raised ridge running down the center. This condition is usually more rigid and less flexible than excavatum.

Note: Both conditions may lead to postural changes such as rounded shoulders or a forward head position due to the altered chest structure.

Respiratory Symptoms

Respiratory symptoms in pectus excavatum may include reduced exercise tolerance and shortness of breath, especially in moderate to severe cases. The sunken sternum can compress the lungs, limiting expansion during deep breaths.

Pectus carinatum generally causes fewer respiratory issues but may result in mild shortness of breath or decreased stamina during exertion. The protrusion often does not restrict lung capacity as severely as excavatum.

Note: Both conditions can lead to inefficiencies in breathing patterns, sometimes causing increased breathing rates during physical activity.

Cardiac Implications

In pectus excavatum, the inward displacement of the sternum can compress the heart, particularly the right atrium and ventricle. This compression may reduce cardiac output and lead to palpitations or chest pain in severe cases.

Pectus carinatum rarely causes direct cardiac compression. However, some patients report discomfort or abnormal heart sounds due to altered chest mechanics or associated conditions.

Note: Both deformities may require cardiac evaluation if symptoms like dizziness, fatigue, or arrhythmias occur, to rule out compromised heart function.

Causes and Risk Factors

Both pectus excavatum and pectus carinatum arise from a combination of genetic and developmental influences. Several underlying conditions and inherited traits contribute to their presence and severity.

Genetic Predisposition

Many cases of both conditions show a hereditary pattern. Relatives of affected individuals often display similar chest wall deformities. This suggests specific genes involved in cartilage growth and connective tissue development may play a key role.

Genetic studies indicate that mutations or variations affecting the rib cage structure and collagen synthesis increase susceptibility. However, no single gene is responsible; rather, a combination likely influences the outcome. Family history remains one of the strongest risk factors.

Developmental Factors

Pectus excavatum and carinatum are believed to result from abnormal growth of the costal cartilage during childhood. This abnormal growth causes the sternum to be pushed inward or outward, respectively.

Rapid growth spurts in adolescence often coincide with worsening deformities. Mechanical forces on the chest wall may also influence the shape during development. Environmental influences are less clearly defined but may interact with genetic predisposition.

Associated Syndromes

Both deformities frequently occur with connective tissue disorders like Marfan syndrome and Ehlers-Danlos syndrome. These syndromes affect collagen and elastin, weakening chest wall structures.

Other conditions, such as Noonan syndrome and homocystinuria, have also been linked to higher rates of these chest wall abnormalities. Patients with these syndromes tend to have more severe or complex presentations. Identifying associated syndromes can guide clinical management and screening.

Diagnostic Methods

Accurate diagnosis of pectus excavatum and pectus carinatum relies on a combination of clinical evaluation and imaging. This approach ensures clear identification of chest wall deformities and helps guide treatment decisions.

Physical Examination

Physical examination is the initial step in diagnosis. The physician observes the chest’s shape, noting the inward depression characteristic of pectus excavatum or the outward protrusion seen in pectus carinatum.

Palpation assesses rigidity and symmetry of the chest wall. The exam often includes measuring the anteroposterior and transverse diameters of the thorax. Physicians also evaluate respiratory function and look for any signs of cardiopulmonary compromise.

Visual inspection during inspiration and expiration helps determine if the deformity changes with breathing. Physical findings alone can often differentiate between the two conditions.

Imaging Techniques

Imaging confirms the diagnosis and provides detailed anatomical information. Chest X-rays are commonly used to visualize the extent and location of the deformity.

Computed tomography (CT) scans offer precise measurements of the chest wall and internal structures. CT helps assess the displacement of the sternum and ribs, especially important for surgical planning.

Magnetic resonance imaging (MRI) can be used, but it is less common due to cost and availability. It may be chosen when soft tissue evaluation is required.

Severity Assessment

Severity assessment involves quantifying the deformity to guide treatment options. The Haller Index is widely used to measure pectus excavatum severity, calculated by dividing the chest’s transverse diameter by the anteroposterior distance.

A Haller Index greater than 3.25 typically indicates severe pectus excavatum. For pectus carinatum, severity is often evaluated by the protrusion’s size and symmetry. Pulmonary function tests and cardiac evaluations help determine whether the deformity affects organ function, influencing the urgency of treatment.

Non-Surgical Treatment Options

Non-surgical options for pectus excavatum and pectus carinatum focus mainly on external correction and physical strengthening. These methods aim to improve chest shape and function without invasive procedures. They require consistent use and professional supervision to be effective.

Bracing Therapies

Bracing is the primary non-surgical treatment for pectus carinatum. Custom-fitted chest braces apply pressure to the protruding sternum, gradually reshaping the chest wall over time. Bracing is most effective in children and adolescents whose bones are still growing.

Patients typically wear the brace for 12 to 23 hours daily, depending on the severity of the condition and the doctor’s recommendations. Treatment usually spans several months to a year. Regular follow-ups are necessary to adjust the fit and monitor progress.

For pectus excavatum, bracing is less common but may be used in mild cases or when surgery is not an option. The brace works to promote a more normal chest contour, though results are generally less dramatic than surgical correction.

Physical Therapy Approaches

Physical therapy targets muscle strengthening and posture improvement to reduce the visual impact of both pectus excavatum and carinatum. Therapy focuses on exercises that expand the chest, strengthen the back and shoulder muscles, and improve breathing capacity.

Common exercises include deep breathing routines, stretching, and resistance training. These help improve respiratory function and support better chest positioning. Physical therapy is often combined with bracing to enhance overall outcomes.

A licensed physical therapist customizes routines based on individual needs and condition severity. Regular sessions and adherence to home exercise programs are essential for achieving and maintaining improvements.

Surgical Treatment Options

Surgical treatments for pectus excavatum and pectus carinatum vary in invasiveness and recovery. Options range from minimally invasive procedures designed to reshape the chest with limited incisions to more extensive open surgeries. Postoperative care is essential to ensure proper healing and optimal results.

Minimally Invasive Procedures

Minimally invasive surgery is common for pectus excavatum, especially the Nuss procedure. It involves inserting a curved metal bar beneath the sternum to elevate the sunken chest. The bar typically remains for 2 to 4 years before removal.

For pectus carinatum, minimally invasive techniques focus on external bracing with surgery reserved for severe cases. If surgery is needed, small incisions may adjust deformities with less tissue disruption. Recovery time is usually shorter, and scarring is minimal.

Note: These procedures reduce hospital stays and have faster recovery compared to open surgery, but require careful patient selection.

Open Surgical Techniques

Open surgery is more common for complex or severe chest wall deformities. The Ravitch procedure is standard for pectus excavatum and carinatum. It involves removing abnormal cartilage and repositioning the sternum through a larger chest incision.

This method allows direct access to chest structures and is useful in recurrent or rigid deformities. The hospital stay is longer, and recovery can take several weeks. Scarring is more noticeable, but results are often durable.

Note: Open techniques may be combined with internal support bars, depending on the correction needed.

Postoperative Care

Postoperative care focuses on pain management, infection prevention, and gradual return to activity. Pain control often involves medications and sometimes nerve blocks. Patients are encouraged to start light movement early to reduce complications.

Monitoring for complications like bar displacement (in minimally invasive cases) or wound infections is critical. Respiratory exercises may be recommended to improve lung function. Follow-up visits assess healing and plan for bar removal if applicable.

Note: Adherence to care instructions directly impacts surgical outcomes and long-term chest wall stability.

Long-Term Outcomes and Prognosis

Both pectus excavatum and pectus carinatum have varying impacts on individuals depending on severity and treatment. Long-term effects focus on how these conditions influence daily life and health risks over time.

Quality of Life Considerations

People with pectus excavatum often report chest discomfort, reduced exercise tolerance, and self-consciousness about appearance. Surgical correction can improve physical symptoms and boost self-esteem, especially in adolescents and young adults.

Pectus carinatum typically causes less physical limitation but may affect social confidence due to visible chest protrusion. Bracing during adolescence is effective for mild to moderate cases and helps reduce psychological distress.

Note: Both conditions may require ongoing monitoring to address respiratory or cardiac function. Pain or discomfort after surgery tends to diminish with time, improving overall well-being.

Potential Complications

Pectus excavatum can occasionally interfere with heart and lung function if untreated, especially in severe cases. Risks include reduced cardiac output and restrictive lung disease. Pectus carinatum rarely causes significant functional impairment but can be associated with asthma or chest wall pain. Untreated deformities may worsen during growth spurts.

Post-surgical complications for both include infection, chest wall stiffness, and implant displacement. Long-term follow-ups are necessary to detect complications early and manage chronic pain or deformities.

FAQs About Pectus Excavatum and Pectus Carinatum

Can You Have Pectus Excavatum and Carinatum?

Yes, it is possible for an individual to have features of both pectus excavatum and pectus carinatum, though this is less common. This mixed presentation is sometimes referred to as a “mixed pectus deformity.”

In such cases, part of the chest may sink inward while another area protrudes outward. The condition can complicate diagnosis and treatment since both deformities affect the chest wall differently.

Note: Management often requires individualized care plans, which may include bracing, physical therapy, or surgical intervention.

What Does Pectus Carinatum Indicate?

Pectus carinatum, also called pigeon chest, typically indicates abnormal growth of the costal cartilage that pushes the sternum outward. In many cases, it is an isolated structural deformity without major health consequences.

However, it can sometimes signal an underlying genetic or connective tissue disorder, such as Marfan or Noonan syndrome. While it usually does not impair organ function, it may cause mild breathing issues, chest pain, or reduced exercise tolerance.

Note: Evaluation by a healthcare professional helps determine its significance and necessary treatment.

Does Pectus Carinatum Get Worse With Age?

Pectus carinatum often becomes more noticeable as children grow, especially during adolescence when growth spurts accelerate cartilage development. The deformity tends to stabilize once skeletal growth is complete, but it does not usually worsen significantly in adulthood.

However, without treatment during growth years, the chest protrusion may become more rigid and harder to correct later. Early detection is important because bracing is most effective while the chest wall is still flexible. Adults may require surgical correction if symptoms or cosmetic concerns persist.

Is Marfan Syndrome Pectus Excavatum or Carinatum?

Marfan syndrome can be associated with both pectus excavatum and pectus carinatum. This genetic connective tissue disorder often weakens the structural integrity of the chest wall, leading to abnormal cartilage growth.

Pectus excavatum, or a sunken chest, is more commonly seen in people with Marfan syndrome, but carinatum also occurs in some cases. The presence of either deformity, combined with other signs such as tall stature, long limbs, and heart issues, may suggest Marfan syndrome.

Note: Medical evaluation is crucial for accurate diagnosis and management.

What Makes Pectus Excavatum Worse?

Pectus excavatum can worsen during periods of rapid growth, particularly in adolescence. The inward depression of the sternum often deepens as the chest wall develops and the costal cartilage grows abnormally. Poor posture, such as slouching or rounded shoulders, may also accentuate the appearance.

In some cases, underlying connective tissue disorders increase severity. Without treatment, the deformity may progress and begin to affect lung expansion or heart function. Regular monitoring by healthcare providers helps determine whether intervention is necessary to prevent complications.

Can You Exercise With Pectus Excavatum?

Yes, most people with pectus excavatum can safely exercise and often benefit from physical activity. Exercises that improve posture, strengthen chest and back muscles, and expand lung capacity may help reduce symptoms and enhance appearance. Activities like swimming, deep breathing exercises, and strength training are especially helpful.

However, in more severe cases where heart or lung function is compromised, exercise tolerance may be reduced. It is important for individuals with significant deformities to consult their physician before beginning or modifying an exercise routine.

Does Overgrowth of Costal Cartilage Cause Pectus Excavatum?

Yes, the primary cause of pectus excavatum is believed to be the overgrowth of costal cartilage, the flexible tissue that connects the ribs to the sternum. This abnormal growth pushes the sternum inward, creating the sunken chest appearance.

The exact reason for the cartilage overgrowth is not fully understood, but genetics are thought to play a role, as the condition often runs in families. Understanding this underlying mechanism is important because it explains why treatments like bracing and surgery target structural correction of the chest wall.

Final Thoughts

Pectus excavatum and pectus carinatum may present in opposite ways, but both share the potential to affect a person’s health, posture, and self-confidence. While excavatum involves a sunken chest and can sometimes compromise heart or lung function, carinatum causes an outward protrusion that may lead to discomfort or cosmetic concerns.

Thankfully, advances in bracing, physical therapy, and surgery provide effective treatment options tailored to each condition.

By understanding the differences, recognizing symptoms early, and seeking proper medical evaluation, individuals with these chest wall deformities can achieve improved physical outcomes, greater comfort, and enhanced quality of life.