Reviewed by Dr. Juan Luo

Dr. Luo specializes in chest wall deformities. She has treated nearly 2,000 patients and performed over 800 corrective surgeries, with a focus on achieving both functional and aesthetic outcomes. She is highly skilled in scar management, employing unique techniques to optimize healing and appearance.

Chest wall deformities affect thousands of children and adolescents worldwide, with pectus excavatum and pectus carinatum representing the two most common forms. While both conditions involve abnormal chest wall development, they manifest in opposite ways and require different treatment approaches. Understanding these key differences is essential for proper diagnosis, treatment planning, and achieving optimal outcomes.

What is Pectus Excavatum?

Pectus excavatum, also known as "funnel chest," is the most common congenital chest wall deformity, occurring in approximately 1 in 300-400 births. This condition is characterized by a depression of the sternum and the adjacent costal cartilages. The degree of depression can vary from mild to severe and is often present in multiple forms (types). While frequently present at birth, it can become more pronounced during adolescence or periods of rapid growth.

Pectus excavatum can exert pressure on the underlying thoracic organs, particularly the heart and lungs. In some cases, this can lead to clinical symptoms such as shortness of breath, exercise intolerance, chest pain, and fatigue. The severity of these symptoms is typically correlated with the depth of the sternal depression. Beyond the physical symptoms, the cosmetic appearance of a sunken chest can lead to significant psychological distress, social anxiety, and a negative self-image, especially in adolescents.

What is Pectus Carinatum?

In stark contrast to its counterpart, pectus carinatum is a chest wall deformity defined by a protrusion of the sternum and costal cartilages. This deformity, colloquially referred to as "pigeon chest"(5-7%), is less common than pectus excavatum(90%), with an estimated incidence of 1 in 1,000-1,500 births. Like pectus excavatum, it is often noticed at birth but can become more prominent during pubertal growth spurts.

While the outward bowing of the chest wall is the primary physical characteristic of a pectus carinatum deformity, it is generally less likely to cause significant physiological impairment. The heart and lungs are typically not compressed by the protruding sternum. However, individuals may still experience mild chest pain, tenderness at the site of protrusion, or, in more severe cases, shortness of breath during strenuous activity. The most significant impact of pectus carinatum is often psychological. The highly visible protrusion can lead to significant psychological distress, causing feelings such as low self-esteem and anxiety.

Pectus Excavatum vs. Pectus Carinatum: Their Key Differences

Understanding the fundamental differences between pectus excavatum and pectus carinatum is crucial for selecting the correct treatments. While both are related to abnormal sternal growth, their presentations and management strategies are distinct.

The following table provides a quick reference for the key characteristics of pectus excavatum vs. pectus carinatum.

Comparison Table: Pectus Excavatum vs. Pectus Carinatum

Detailed Analysis of Their Significant Differences

A deeper dive into the distinctions reveals why a different approach is required for each condition. The key differences lie in their anatomical manifestation, clinical presentation, and subsequent treatment paradigms.

1. Anatomical and Clinical Presentation:

The core difference between pectus excavatum vs. carinatum is the direction of the sternal displacement. Pectus excavatum is characterized by an inward depression of the sternum along with the attached costal cartilages. This inward collapse can compress the heart, particularly the right ventricle, and the lungs, leading to a reduction in both cardiac output and lung capacity. This is why patients with severe pectus excavatum often report physiological symptoms like palpitations, shortness of breath on exertion, and chest pain.

Conversely, pectus carinatum is characterized by a forward protrusion of the sternum and its adjoining costal cartilages. This protrusion does not typically compress the vital organs. The most common physical symptoms are mild chest wall tenderness or discomfort, and the primary complaint for most patients is the aesthetic appearance. This key difference in physical impact is the main reason that treatment for pectus carinatum often begins with less invasive options.

2. Incidence and Psychological Impact:

As the most common chest wall deformity, pectus excavatum is a more frequently encountered condition. Its prevalence contributes to a greater body of research and a more established range of treatment options.

However, both conditions can have a profound psychological effect on patients, especially during formative years. The visible nature of these deformities can lead to body image issues, social avoidance, and reduced quality of life.

3. Surgical Treatment:

Severe cases with significant physiological compromise are often managed surgically. The difference in pathology between pectus excavatum and pectus carinatum dictates their respective treatment strategies.

1) For Pectus Excavatum

• Nuss Procedure – A minimally invasive procedure where curved metal bars are inserted into the chest cavity and passed through the heart surface to push it outward. It is kept in place for 2 or 3 years to allow the chest wall to remodel.

• Ravitch Procedure – A more conventional operation where deformed cartilage is removed and the sternum is rearranged, providing direct correction.

• Wang Procedure – An innovative surgical method for pectus excavatum designed for children under 10 years old. In contrast to the Nuss procedure, the Wang procedure places a bar on the surface of the concave sternum and ribs for correction, thereby avoiding potential cardiac injury.

• Wung Procedure – A modified minimally invasive surgery based on the Nuss procedure, but with significant technical improvements (such as the "Wang Technique" for bar fixation) that have substantially reduced surgical risks.

Learn more about Nuss vs. Wang vs. Wung procedure: 3 Minimally Invasive Surgeries for Pectus Excavatum 

2) For Pectus Carinatum

• The modified Ravitch procedure is a common surgical approach for pectus carinatum surgery. 

• Abramson Procedure – This is a minimally invasive surgery for pectus carinatum. In this procedure, a presternal metal correctional bar, secured to rib-attached stabilizers, is implanted to redress the sternum to a neutral position.

• Wenlin Procedure – This is an innovative minimally invasive surgery pioneered by Dr. Wenlin Wang, specifically designed for the treatment of pectus carinatum. The Wenlin procedure effectively avoids the drawbacks and risks of the Abramson procedure, offering a safer, simpler, and less traumatic approach with more optimal corrective outcomes.

Finding Doctors and Professional Solutions

Selecting an experienced specialist is crucial for achieving the best treatment outcomes. ICWS is the world's largest chest wall deformity correction center, as well as the world's first independent surgical institution for chest wall disorders. Founded by Dr. Wenlin Wang, ICWS specializes in chest wall deformities and has pioneered a variety of innovative surgical techniques, including the Wang procedure, the Wung procedure, and the Wenlin Procedure. ICWS provides the most advanced treatment solutions for patients with complex and rare chest wall deformities.