Chest Wall Deformities

  • Robert C. ShambergerEmail author
Living reference work entry


A broad spectrum of anomalies occur in the chest wall, ranging from pectus carinatum, a protrusion anomaly, to pectus excavatum, a depression anomaly, to actual absence of the ribs and pectoral muscle in Poland’s syndrome. These deformities, which are the most frequent to occur, will be discussed in this chapter including their physiologic implications for the patient as well as frequent approaches to treatment. The devastating deformities of ectopia cordis and sternal defects are much rarer and as such will not be discussed.


Pectus Excavatum Pectus Carinatum Poland’s Syndrome 


  1. Abramson H, D’Agostino J, Wuscovi S. A 5-year experience with minimally invasive technique for pectus carinatum repair. J Pediatr Surg. 2009;44:118–24.PubMedGoogle Scholar
  2. Adkins PC, Blades B. A stainless steel strut for correction of pectus excavatum. Surg Gynecol Obstet. 1961;113:111–3.PubMedGoogle Scholar
  3. Al-Qattan M. Classification of hand anomalies in Poland’s syndrome. Br J Plast Surg. 2002;54:132–6.Google Scholar
  4. Baronofsky ID. Technique for correction of pectus excavatum. Surgery. 1957;42:884–90.PubMedGoogle Scholar
  5. Beiser GD, et al. Impairment of cardiac function in patients with pectus excavatum, with improvement after operative correction. N Engl J Med. 1972;287:267–72.PubMedGoogle Scholar
  6. Brodkin H. Pigeon breast – congenital chondrosternal prominence. Arch Surg. 1958;77:261–70.Google Scholar
  7. Cahill JL, et al. A summary of preoperative and postoperative cardiorespiratory performance in patients undergoing pectus excavatum and carinatum repair. J Pediatr Surg. 1984;19:430–3.PubMedGoogle Scholar
  8. Catena N, Divizia MT, Calevo MG, et al. Hand and upper limb anomalies in Poland syndrome: a new proposal of classification. J Pediatr Orthop. 2012;32:722–6.Google Scholar
  9. Chin E. Surgery of funnel chest and congenital sternal prominence. Br J Surg. 1957;44:360–76.PubMedGoogle Scholar
  10. Clarkson P. Poland’s syndactyly. Guys Hosp Rep. 1962;111:335–46.PubMedGoogle Scholar
  11. Colozza S, Bütter A. Bracing in pediatric patients with pectus carinatum is effective and improves quality of life. J Pediatr Surg. 2013;48:1055–9.PubMedGoogle Scholar
  12. Croitoru DP, et al. Experience and modification update for the minimally invasive Nuss technique for pectus excavatum repair in 303 patients. J Pediatr Surg. 2002;37:437–45.PubMedGoogle Scholar
  13. Currarino G, Silverman F. Premature obliteration of the sternal sutures and pigeon-breast deformity. Radiology. 1958;70:532–40.PubMedGoogle Scholar
  14. Egan J, DuBois J, Morphy M, et al. Compressive orthotics in the treatment of asymmetric pectus carinatum: a preliminary report with an objective radiographic marker. J Pediatr Surg. 2000;35:1183–6.PubMedGoogle Scholar
  15. Frey A, Garcia V, Brown R, et al. Nonoperative management of pectus carinatum. J Pediatr Surg. 2006;41:40–5.PubMedGoogle Scholar
  16. Froriep R. Beobachtung eines Falles von Mangel der Brustdruse. Notizen Geb Natur Heilkunde. 1839;10:9–14.Google Scholar
  17. Goretsky MJ, McGuire MM. Complications associated with the minimally invasive repair of pectus excavatum. Semin Pediatr Surg. 2018;27(3):151–5.PubMedGoogle Scholar
  18. Haje S, Bowen J. Preliminary results of orthotic treatment of pectus deformities in children and adolescents. J Pediatr Orthop. 1992;12:795–800.PubMedGoogle Scholar
  19. Haller JJ, Colombani P, Miller D, et al. Early reconstruction of Poland’s syndrome using autologous rib grafts combined with latissimus muscle flap. J Pediatr Surg. 1984;19:423–9.PubMedGoogle Scholar
  20. Haller JJ, et al. Use of CT scans in selection of patients for pectus excavatum surgery: a preliminary report. J Pediatr Surg. 1987;22:904–6.PubMedGoogle Scholar
  21. Howard R. Pigeon chest (protrusion deformity of the sternum). Med J Aust. 1958;45:664–6.PubMedGoogle Scholar
  22. Kelly RJ, et al. Prospective multicenter study of surgical correction of pectus excavatum: design, perioperative complications, pain, and baseline pulmonary function facilitated by internet-based data collection. J Am Coll Surg. 2007;205:205–216.PubMedGoogle Scholar
  23. Kelly R, et al. Surgical repair of pectus excavatum markedly improves body image and perceived ability for physical activity: Multicenter Study. Pediatrics. 2008;122:1218–22.PubMedGoogle Scholar
  24. Kelly R, et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg. 2010;252:1072–81.PubMedGoogle Scholar
  25. Kelly R, et al. Multicenter study of pectus excavatum, final report: complications, status/exercise pulmonary function, and anatomic outcomes. J Am Coll Surg. 2013;217:1080–9.PubMedGoogle Scholar
  26. Lee R, Moormon S, Schneider M, et al. Bracing is an effective therapy to pectus carinatum: interim results. J Pediatr Surg. 2013;48:184–90.PubMedGoogle Scholar
  27. Lees R, Caldicott J. Sternal anomalies and congenital heart disease. Am J Roentgenol Radium Therapy, Nucl Med. 1975;124:423–7.Google Scholar
  28. Lester C. Pigeon breast (pectus carinatum) and other protrusion deformities of the chest of developmental origin. Ann Surg. 1953;137:482–9.PubMedPubMedCentralGoogle Scholar
  29. Notrica DM. The Nuss procedure for repair of pectus excavatum: 20 error traps and a culture of safety. Semin Pediatr Surg. 2019;28(3):172–7.PubMedGoogle Scholar
  30. Nuss D, et al. A 10 year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg. 1998;33:545–52.PubMedGoogle Scholar
  31. Peterson RJ, et al. Noninvasive assessment of exercise cardiac function before and after pectus excavatum repair. J Thorac Cardiovasc Surg. 1985;90:251–60.PubMedGoogle Scholar
  32. Poland A. Deficiency of pectoralis muscles. Guy’s Hospital Rep. 1841;6:191–3.Google Scholar
  33. Ravitch MM. The operative treatment of pectus excavatum. Ann Surg. 1949;129:429–44.PubMedPubMedCentralGoogle Scholar
  34. Ravitch M. Unusual sternal deformity with cardiac symptoms-operative correction. J Thorac Surg. 1952;23:138–44.PubMedGoogle Scholar
  35. Ravitch M. The operative correction of pectus carinatum (pigeon breast). Ann Surg. 1960;151:705–14.PubMedPubMedCentralGoogle Scholar
  36. Rehbein F, Wernicke HH. The operative treatment of the funnel chest. Arch Dis Child. 1957;32:5–8.PubMedPubMedCentralGoogle Scholar
  37. Robicsek F, Sargar P, Taylor F, et al. The surgical treatment of chrondrosternal prominence (pectus carinatum). J Thorac Cardiovasc Surg. 1963;45:691–701.PubMedGoogle Scholar
  38. Saour S, Shaaban H, McPhail J, et al. Customised silicone prostheses for the reconstruction of chest wall defects: technique of manufacture and final outcome. J Plast Reconstr Anesthet Surg. 2008;61:1205–9.Google Scholar
  39. Shamberger R, Welch K. Surgical correction of pectus carinatum. J Pediatr Surg. 1987;22:48–53.PubMedGoogle Scholar
  40. Shamberger RC, Welch KJ. Surgical Repair of Pectus Excavatum. J Pediatr Surg. 1988;23:615–622.Google Scholar
  41. Shamberger R, Welch K, Upton J III. Surgical treatment of thoracic deformity in Poland’s syndrome. J Pediatr Surg. 1989;24:760–5.PubMedGoogle Scholar
  42. Welch KJ. Satisfactory surgical correction of pectus excavatum deformity in childhood: a limited opportunity. J Thorac Surg. 1958;36:697–713.PubMedGoogle Scholar
  43. Welch K, Vos A. Surgical correction of pectus carinatum (pigeon breast). J Pediatr Surg. 1973;8:659–67.PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Department of SurgeryBoston Children’s Hospital & Harvard Medical SchoolBostonUSA

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