Funnel chest, also known as pectus excavatum, is a congenital chest wall deformity characterized by a depression of the sternum and lower costal cartilages. It is the most common chest wall deformity, affecting approximately 1 in 400 births.

Anatomy and Pathophysiology

• The sternum and adjacent costal cartilages are displaced posteriorly, creating a concave appearance of the anterior chest wall.
• The deformity typically worsens during adolescent growth spurts.
• In severe cases, it can compress the heart and lungs, potentially leading to cardiopulmonary impairment.

Clinical Presentation

• Visible depression of the anterior chest wall
• Asymmetry of the chest (in some cases)
• Possible associated scoliosis or kyphosis
• In severe cases:
  • Decreased exercise tolerance
  • Shortness of breath
  • Chest pain
  • Palpitations

Diagnosis

• Physical examination
• Chest X-ray
• CT scan (to assess severity and calculate Haller index)
• Echocardiogram and pulmonary function tests (to evaluate cardiopulmonary impact)

Treatment

Treatment depends on the severity of the deformity and associated symptoms:

Observation: For mild cases without symptoms

Non-surgical approaches:

• Vacuum bell therapy
• Specific exercises to improve posture and chest wall flexibility

Surgical correction:

• Nuss procedure (minimally invasive repair)
• Ravitch procedure (open surgical repair)

Indications for surgery typically include:

• Severe deformity (Haller index > 3.25)
• Cardiopulmonary symptoms
• Significant psychological distress

Prognosis

• Most patients have a good prognosis with appropriate management.
• Surgical correction can lead to significant improvements in both cosmetic appearance and cardiopulmonary function.