pectus carinatum

Pectus carinatum results from overgrowth of the costal cartilages, pushing the sternum outward, creating a protruding, keel-like chest wall deformity. It can be classified as chondrogladiolar (most common, sternum protrudes forward) or chondromanubrial (rarer, more severe). It is often diagnosed during the adolescent growth spurt and is more common in males. Associations include Marfan syndrome, Ehlers-Danlos syndrome, homocystinuria, osteogenesis imperfecta, and other connective tissue disorders, as well as congenital heart disease and scoliosis. Unlike pectus excavatum, it rarely causes cardiopulmonary compromise, though some patients report decreased exercise tolerance or restrictive lung changes in severe cases. Diagnosis is clinical, though chest CT or X-ray can assess severity and rule out associated anomalies. Management is primarily for cosmetic concerns and psychosocial impact, especially in adolescents. Bracing (compressive orthotic therapy) is effective if started early during growth, applying sustained pressure to remodel the cartilage. Surgical correction (modified Ravitch procedure) is reserved for severe or refractory cases. Differentiating from pectus excavatum (sternal depression, associated with Marfan syndrome and can cause cardiopulmonary symptoms due to compression) is a key board distinction.