Which Department Should You Visit for Pectus Excavatum? What Are the Treatment Options?

Introduction

When parents notice a sunken or abnormally shaped chest in their child, the first questions that come to mind are: Which medical department should we visit? What tests will be done? What treatment options are available after diagnosis?

These are common concerns for many parents before a medical visit. This article provides a detailed introduction to the choice of department, the diagnostic process, and the main treatment options for Pectus Excavatum, helping parents prepare for their visit [1].

1. Which Department Should You Visit for Pectus Excavatum?

1. Primary Departments: Paediatric Surgery or Thoracic Surgery

Pectus excavatum is a congenital chest wall deformity. The choice of department mainly depends on the hospital’s setup and the child’s age [1].

• Paediatric Surgery – The first choice for children under 14 years. Paediatric surgeons have a better understanding of chest development in children and can formulate appropriate diagnosis and treatment plans based on the child’s age and severity of the deformity [2].

• Paediatric Thoracic Surgery or Paediatric Orthopaedics – If the hospital does not have an independent paediatric surgery department, these specialties can be considered.

2. For Adults: Thoracic Surgery

If the patient is already an adult, the department of choice is Thoracic Surgery. Adult thoracic surgeons have extensive experience in pectus excavatum surgery and can select the appropriate surgical method based on the patient’s specific condition.

3. Ancillary Departments That May Be Involved

The following departments may also be involved during diagnosis and treatment:

4. Preparation Before the Visit

Before taking your child to see a doctor, it is recommended that parents prepare the following:

• Medical history – When the depression was first noticed, how it has changed, family history, etc.

• Previous medical records – Bring any previous X‑rays, test reports, etc., for the doctor to review.

• Symptom record – Whether the child has difficulty breathing, reduced exercise tolerance, chest tightness, etc.

• Photos – Frontal and lateral chest photos to help the doctor understand the shape changes.

2. What Tests Are Needed for Pectus Excavatum?

1. Physical Examination

The doctor will assess the chest wall through inspection and palpation:

• Location, depth, and symmetry of the chest depression

• Chest wall mobility

• Presence of associated deformities such as scoliosis

• Signs of heart or lung involvement

2. Imaging Studies

Chest CT is the gold standard for evaluating pectus excavatum [1]. CT can:

• Precisely measure the depth of the depression (Haller Index)

• Assess the degree of heart and lung compression caused by the depression

• Visualise the three‑dimensional shape of the chest

• Rule out other chest wall diseases

Electrocardiogram (ECG) and echocardiography are used to assess whether cardiac function is affected by compression.
Pulmonary function tests can detect any restrictive ventilatory impairment [3].

3. Severity Assessment: The Haller Index

The Haller Index (the ratio of the transverse chest diameter to the distance from the anterior sternum to the spine on a CT cross‑section) is used clinically to classify severity [4].

Note: Severity assessment is not based solely on the Haller Index – the child’s symptoms (exercise tolerance, cardiopulmonary effects) and subjective feelings should also be considered [4].

3. What Are the Treatment Options for Pectus Excavatum?

Treatment options for pectus excavatum are mainly divided into non‑surgical correction and surgical treatment [1]. The choice depends on the child’s age, severity of the deformity, symptoms, and parental preferences.

1. Non‑Surgical Correction

Vacuum Bell (Negative Pressure Device)

The vacuum bell has gained attention in recent years as a non‑surgical correction method [5]. A negative pressure device is placed over the depressed area to create a continuous suction, gradually lifting the sunken sternum outward.

Indications: Children and adolescents with mild‑to‑moderate pectus excavatum whose skeletons still have good plasticity [5].

Advantages:

• Non‑invasive, no surgery

• Can be used at home

• Does not interfere with daily life

• Correction parameters can be adjusted as needed

Limitations:

• Requires long‑term consistent use

• May have limited effect in severe deformities

• Requires professional guidance

2. Surgical Treatment

Nuss Procedure (Minimally Invasive Repair of Pectus Excavatum)

The Nuss procedure is the most commonly used surgical treatment for pectus excavatum [6]. Under thoracoscopic guidance, the surgeon places a curved metal bar behind the depressed sternum, using the bar’s support to lift the sternum.

Indications: Moderate‑to‑severe pectus excavatum, poor response to conservative treatment, or when parents desire rapid improvement [6].

Optimal age: Usually 6–16 years, when the skeleton is still relatively flexible [6].

Advantages:

• Small incisions, less trauma than traditional open surgery

• Reliable correction effect

• Shorter hospital stay

Limitations:

• Implanted foreign body (metal bar) requires a second surgery for removal

• Surgical risks (bleeding, infection, pneumothorax, etc.)

• Requires recovery time after surgery

Ravitch Procedure (Open Surgery)

This is the traditional open surgery for pectus excavatum. It involves a midline chest incision, cutting the costal cartilages, and refixing the sternum in a corrected position. It is now less commonly used but may still be employed in certain special cases [6].

3. How to Choose a Treatment Option?

Treatment selection should take the following factors into account [1]:

Parents are advised to communicate thoroughly with their healthcare provider and understand the pros and cons of each treatment option before making a decision.

4. Frequently Asked Questions (FAQ)

Q1: My child is still young. Can we wait until they are older to treat pectus excavatum?

A: This depends on the severity of the deformity and the presence of symptoms. Children with mild deformities and no obvious symptoms can be observed regularly. However, it is important to note that pectus excavatum tends to be progressive, especially before puberty. Regular follow‑ups are recommended so that the specialist can assess whether timely intervention is needed [2].

Q2: Will pectus excavatum go away on its own?

A: No. Pectus excavatum is a structural deformity and will not resolve spontaneously. As the child grows, the skeleton gradually hardens, making correction more difficult. Therefore, early detection, early assessment, and early intervention are the basic principles.

Q3: Which is better – non‑surgical correction or surgery?

A: The two methods have different indications and cannot be simply compared. Non‑surgical correction is suitable for mild‑to‑moderate deformities in younger children whose families are willing to commit to long‑term treatment. Surgery is suitable for moderate‑to‑severe deformities with significant symptoms when rapid improvement is desired. The choice should be made based on professional advice.

Q4: Is there a risk of recurrenc