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► Pectus Excavatum

Pectus Excavatum

Also known as: sunken chest, funnel chest, Cobbler's chest

What is Pectus Excavatum?

Pectus excavatum, Latin for “hollowed chest,” is the most common chest wall deformity. It may also be referred to as sunken chest, hollow chest, or concave chest. This condition is characterized by a distinctly depressed sternum (breastbone), which in some patients is evident at birth, and for others develops later, typically during adolescence. In severe cases, pectus excavatum can affect the heart and lungs, while less severe cases often impact a child’s or teen’s self-image.

Causes of Pectus Excavatum

Pectus excavatum will often occur by itself without any family history or other defects or problems. Other causes include:

Pectus Excavatum


Patients with pectus excavatum may experience shortness of breath, chest pain, and exercise intolerance. Surgery may be necessary to relieve discomfort and prevent heart and breathing abnormalities.


Computed tomography (CT) scans are used to image the internal structures of the chest to assess the severity of the depression. Doctors  may also arrange for pulmonary function and cardiac evaluations to determine the impact of the deformity on each individual.

The Haller index (dividing the width of the rib cage by the distance from the sternum to the spine) is often used to evaluate the severity of pectus excavatum. A normal index is about 2.5, while an index greater than 3.2 may be severe enough to indicate surgical correction.

Surgical Treatment Options

Options are reviewed and a course of treatment for pectus excavatum is selected with input from the family, based on the severity and asymmetry of the defect. Operative repair is customized to best correct the specific condition noted in each patient. The Chest Wall Deformity Center of Excellence at Nicklaus Children's Hospital offers both traditional surgeries as well as minimally-invasive operations for pectus excavatum treatment.

The Ravitch procedure, developed in the 1940s, is a technique that involves opening the chest cavity. With this technique, small sections of rib cartilage are removed, and the sternum is raised. Metal bars, called struts, may be implanted to hold the chest wall in place to reshape the chest. These may then be removed about six months after the operation.

The Nuss procedure, developed in the 1990s, is a minimally invasive procedure. With this pectus excavatum treatment, a small incision is created under each armpit, with a third tiny incision made for insertion of a thin camera. The camera guides the surgeon in implanting a curved metal bar under the sternum allowing immediate correction of the sunken appearance of the chest. These bars may be removed after several years, once the new bone structure is established.

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