What is a funnel chest and how is it treated?

Funnel chest occurs when there is a cup-like deformity, usually in the lower part of the chest. This is known as ‘pectus excavatum’ and is also commonly known as ‘sunken chest’. It is much more common in boys than in girls and often becomes more pronounced during adolescence. It occurs in approximately 1 in every 500 births and there is often a family history of the condition, although no specific genetic abnormality has been identified.

There are a number of symptoms that patients can experience with this condition such as shortness of breath and chest pain. Severe cases with deep ‘funnels’ can sometimes affect the functioning of the heart and lungs. However, even mild cases can often be debilitating for growing children because of the psychological impact it has on their self-confidence and should not be projected.

Diagnosing the condition is fairly simple and can be achieved through an examination by an experienced doctor who is familiar with these conditions. Diagnosis does not involve any specific blood tests or scans, but there are several investigations that may be helpful in underlining its severity. A CT scan that tells us how deep the sternum is pushed in relation to other organs in the chest. Other scans such as MRI, especially in children, avoid radiation and give us similar information.

Treatment of this condition is manifold and depends largely on the age of presentation and the exact nature of the pathology (from the scan). Young children with mild deformities can sometimes be treated with a suction device called a ‘vacuum bell’ that helps suck the chest wall back into shape.

Older children and adults are often treated with surgical repair using a minimally invasive procedure called the modified Nuss Bar procedure. This involves making small cuts in the chest wall and creating a ‘tunnel’ under the suppressed part of the chest and inserting a metal bar that pushes the chest back to a more normal position. This procedure has now become universally widespread with excellent results.

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