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Funnel chest (pectus excavatum)
Pectus excavatum is seen in what lesions?
Pectus excavatum can be divided into two categories: The first type is simple pectus excavatum, and the second type is pectus excavatum combined with other diseases. Simple pectus excavatum is a condition in itself and can exist independently, meaning that children with pectus excavatum may not have other pre-existing diseases. Of course, there is also pectus excavatum combined with other diseases, the most common of which are connective tissue disorders, where the incidence of pectus excavatum is significantly higher among patients. This suggests that pectus excavatum may be closely related to the genes that promote or inhibit cartilage development. Additionally, pectus excavatum may also be related to diseases in patients with congenital diaphragmatic hernia. Some cases of congenital Marfan syndrome may also be related, as well as some children who might have airway stenosis or congenital diseases of the lungs and bronchi. These types of congenital diseases may also be accompanied by pectus excavatum. In summary, whether it is simple pectus excavatum or that combined with other diseases, it can itself form a pathological condition and may also be accompanied by other congenital diseases, leading to secondary pathological changes.
Does pectus excavatum affect enlistment?
Regarding the current conscription system, a mild case of pectus excavatum does not affect enlistment. However, it is known that the sternum is positioned directly in front of the heart and lungs in a normal individual. In children or patients with pectus excavatum, the inward and backward indentation of the sternum can directly compress the heart or lungs. In severe cases, this compression can prevent the heart from expanding effectively and fully, severely compressing and deforming the heart, and even affecting the opening and closing of the valves within the heart, leading to incomplete valve closure. As a result, the cardiac and pulmonary functions of such patients can be impacted to a certain extent, especially in those with moderate or severe pectus excavatum. Without timely correction, this condition can impair the patient's ability to perform physical activities, particularly strenuous labor or training exercises in the military, impacting both heart and lung functions. In addition to the physical aspects, there is also a social impact within the military. Due to the deformity of the chest cavity, patients might face misunderstanding or discrimination from others in their unit, which can damage their self-confidence and even lead to feelings of inferiority.
Can funnel chest recover by supplementing with calcium?
There was a time when many parents consulted about calcium supplementation for pectus excavatum, not only many parents but also many doctors in primary hospitals thought that pectus excavatum was caused by a lack of calcium. However, it was found that many children with pectus excavatum are actually very tall and slender. So, can these tall children also be lacking calcium? In fact, calcium deficiency leads to rickets, where beading deformities form between the hard bones and cartilage of the ribs, appearing on both sides. This beading deformation and the inward, backward indentation of the sternum seen in pectus excavatum are completely different conditions. Pectus excavatum is mostly caused by congenital genetic factors, while calcium deficiency or supplementation relates to an acquired condition. Thus, these congenital and acquired diseases are unrelated, meaning that calcium supplementation has no restorative effect on pectus excavatum.
Pectus excavatum should go to which department?
Regarding the registration of patients or children with pectus excavatum, if it is for children and the consultation is only about the hereditary aspect of pectus excavatum or its etiology, consider registering at the pediatrics or child health department. It is also feasible to consult the genetics department. If the consultation is about treatment options for pectus excavatum, including methods of treatment, consider registering at the thoracic surgery department. Thoracic surgery can provide advice and methods for the treatment of pectus excavatum, including both surgical and non-surgical options. Of course, not all hospitals have a thoracic surgery department; generally, municipal third-level, first-class hospitals are equipped with thoracic surgery departments. If there is no thoracic surgery available, consider registering under the general surgery department.
Is pectus excavatum hereditary?
In current medical technology, although no genes exclusively associated with pectus excavatum have been identified, there is evidence suggesting genetic predisposition when pectus excavatum coincides with other conditions. For instance, the incidence of pectus excavatum is significantly higher in patients with congenital connective tissue disorders, such as Marfan Syndrome, and is linked to certain genes within this syndrome. Additionally, patients with congenital diaphragmatic hernia also show an increased incidence of pectus excavatum. Moreover, the condition is more prevalent in patients, or children, who have subglottic airway stenosis or congenital bronchopulmonary dysplasia. Thus, these evidences confirm that pectus excavatum, as a disease in itself, is directly or indirectly related to congenital genetic factors, indicating a certain hereditary nature.
Why can't people with funnel chest gain weight?
In clinical observations, we have found that children with pectus excavatum generally do not have as good nutrition as normal children, and are not as plump. This may be related to the deformity of the chest indentation. We know that the normal cross-section of the thorax on a CT scan is oval-shaped, with the heart and lungs located behind the sternum. In children with pectus excavatum, the sternum is compressed backward toward the spine, which deforms and even pushes the heart completely to one side. This compression of the heart limits the blood's ability to fully return to the heart, and may even prevent the valves from closing completely, leading to valve insufficiency. As a result, both cardiac and pulmonary functions are somewhat impaired. Therefore, 80% of children with pectus excavatum experience exercise intolerance, meaning they cannot run as well as normal children, which also indicates poorer physical fitness and, comparatively, a lesser appetite. Recent studies have found that children with pectus excavatum also have slightly weaker immune functions, and their digestive and absorption capabilities are not as good as those of typical children. Poor exercise capacity and digestive function ultimately lead to poorer nutrition in children with pectus excavatum, making them less plump than normal children.
Can funnel chest heal itself?
Actually, a portion of children with pectus excavatum can heal on their own, especially those who are newly born and discovered to have pectus excavatum. This is because children are curled up while in the mother's womb. In some cases, their hands and feet might be placed in front of the sternum, pressing it backward and inward, causing a deformity. However, once the mother gives birth and the child's limbs unfold, the pressure on the sternum is relieved. As the chest grows, it gradually returns to its normal shape, and these children with pectus excavatum can be cured. On the other hand, another group of patients do not have pectus excavatum at birth, but develop a noticeable chest indentation as they grow older. These patients, when they are young, can also be treated with conservative methods, such as using a vacuum bell for pectus excavatum to gradually draw the indentation outward. With its stabilizing effect, as the child grows, the deformity can be slowly corrected. Of course, there are also children who might have a more rapid skeletal development, and essentially become "set" in their ways. At this stage, they may require surgical intervention to treat the condition. In summary, a portion of pectus excavatum patients can be healed, while another portion requires active intervention and treatment.
Does pectus excavatum hurt?
The sternum of pectus excavatum caves inward and backward, directly compressing the patient's heart or lungs, causing a certain degree of chest pain. This chest pain is not caused by pectus excavatum itself, but by the compression of the heart or lungs due to pectus excavatum. Imagine a normal ribcage as an oval shape; its cross-section is also oval and is a ratio of the patient's left-right diameter, transverse diameter, and anterior-posterior diameter. In normal individuals, this ratio is less than 2.5. In pectus excavatum, since the anterior-posterior diameter is significantly reduced and the sternum is markedly pressed towards the spine, the patient's heart is entirely compressed and deformed. Therefore, the patient's coronary arteries or valves may be squeezed and deformed, resulting in about 60% of pectus excavatum patients experiencing chest pain.
Postoperative care for pectus excavatum
Pectus excavatum surgery involves implanting a metal plate in the patient's body; however, this type of metal plate cannot be welded to normal bones or muscles. It is only fixable using stainless steel wires or sutures. Therefore, postoperative care is crucial. Good post-surgical care significantly reduces the chances of the metal plate shifting. We recommend that patients lie flat on their backs for 3 to 5 days after the surgery, avoid bending, twisting their bodies, or rolling over in bed for a week. For a month, it's important for patients to keep their bodies straight and stand flush against a wall. Since the chest will be quite painful after the surgery, standing against a wall helps the patient maintain a proper posture. Otherwise, due to the pain, the patient may stoop forward, resulting in a hunched posture, which is unappealing and not good for the spine. Within two months post-surgery, the patient should avoid bending over to lift heavy objects as this can lead to uneven distribution of force that may cause the metal plate to shift. Intense physical activities should be avoided for three months. The patient should ideally rest in a supine position and avoid external injuries and contact or impact sports like basketball, soccer, or football. Generally, the metal plate should be removed 2 to 3 years after the surgery depending on the circumstances, so regular clinic visits are necessary to monitor the situation of the plate. If the patient experiences difficulty breathing or chest pain after being discharged from the hospital, they should immediately go to the nearest hospital to have their chest x-rayed to check the status of the metal plate.
Pectus excavatum should see which department?
If the patient is relatively young, under 14 years old, and wishes to consult about pectus excavatum care, pediatric healthcare can be considered. However, if the patient is older, or in addition to pediatric healthcare advice, seeks information on how to treat pectus excavatum, it is advisable to consult with a local thoracic surgery department, if available. This is because thoracic surgeons offer not only information on the causes or care of pectus excavatum but also treatment options. Both conservative treatment plans and surgical interventions are available from thoracic surgeons. Of course, not all hospitals have a department of thoracic surgery, but general top-tier hospitals typically do; if there is no thoracic surgery available locally, considering general surgery might be the only alternative.