The causes of non-hereditary (sporadic) malformations of the anterior chest wall are unknown. Any teratogenic factors acting on the developing fetus can lead to this. Most often congenital deformities of the chest in children are due to uneven growth of the sternum and costal cartilage, diaphragm pathology (short muscle fibers can pull the sternum inward), pathology of the development of cartilage and connective tissue.
According to the time of development and influencing causal factors, congenital and acquired deformities of the chest in children are distinguished. Congenital deformities can be due to genetic causes or occur as a result of impaired skeletal development (sternum, ribs, spine, shoulder blades) in the prenatal period.
Hereditary chest deformities in certain families occur in children in 20-65% of cases. Currently, there are many syndromes, one of the components of which are the defects of the sterno-costal complex.
The most common among them is Marfan syndrome, characterized by asthenic physique, arachnodactyly, funnel and keeled chest deformity, dissecting aortic aneurysm, subluxation and dislocation of the lens, biochemical changes in the metabolism of glycosaminoglycans and collagen. The basis of the formation of hereditary deformities of the chest in children is dysplasia of cartilage and connective tissue, which develops as a result of various kinds of enzymatic disorders.
Acquired chest deformities in children, as a rule, develop as a result of postponed diseases of the musculoskeletal system – rickets, tuberculosis, scoliosis, systemic diseases, rib tumors (chondromas, osteomas, exostoses), rib osteomyelitis, etc. cells are caused by inflammatory diseases of the soft tissues of the chest wall (cellulitis) and pleura (chronic empyema), mediastinal tumors (teratoma, neurofibromatosis, etc.), injuries and burns of the chest, emphyse light oh. In addition, the deformation of the chest in children may be due to poor results of thoracoplasty, median sternotomy for congenital heart defects.
Classification of chest deformities in children
By type of chest deformity in children can be symmetrical and asymmetrical (right-handed, left-handed). Among congenital deformities of the chest in children in pediatric funnel chest (pectus excavatum) and keeled chest (pectus carinatum) are more common. Rare congenital deformities of the chest (about 2%) include Polanda syndrome, sternum cleft, etc.
Funnel deformity of the chest in children (“shoemaker’s chest”) is about 85-90% of congenital defects of the chest wall. Its characteristic feature is the retraction of the sternum and anterior regions of the ribs of various shapes and depths, accompanied by a decrease in the volume of the thoracic cavity, displacement and rotation of the heart, curvature of the spine.
The severity of funnel chest deformity in children can be of 3 degrees:
- I – depression of the sternum up to 2 cm; the heart is not displaced;
- II – depression of the sternum 2-4 cm; heart displacement less than 3 cm;
- III – depression of the sternum more than 4 cm; heart shift more than 3 cm.
Keel-like deformity of the chest (“pigeon”, “chicken” breast) in children is less common than funnel; with 3 of the 4 cases of anomalies occur in boys. In the keeled chest, the ribs attach to the sternum at a right angle, “pushing” it forward, increasing the anterior-posterior size of the chest and giving it the shape of a keel.
The degrees of keeled chest deformity in children include:
- I – protrusion of the sternum up to 2 cm above the normal surface of the chest;
- II – protrusion of the sternum from 2 to 4 cm;
- III – protrusion of the sternum from 4 to 6 cm.
The acquired deformity of the chest in children is divided into kyphoscoliotic, emphysematous, scaphoid, and paralytic.
Symptoms of chest deformities in children
The clinical manifestations of funnel chest deformity vary depending on the age of the child. In infants, the indentation of the sternum is usually unobtrusive, but the “paradox of inhalation” is noted – the sternum and ribs sink when inhaling, when the child screams and cries. In young children, the funnel becomes more visible; there is a tendency to frequent respiratory infections (tracheitis, bronchitis, recurrent pneumonia), fatigue in games with peers.
The funnel-shaped deformation of the chest reaches its greatest intensity in children of school age. On examination, a flattened ribcage with raised edges of ribs, lowered shoulder girdle, protruding belly, thoracic kyphosis, lateral curvatures of the spine are determined. The “paradox of inhalation” is noticeable with deep breathing. Children with funnel chest deformity have a reduced body weight, pale skin. Characterized by low physical endurance, shortness of breath, sweating, tachycardia, pain in the heart, arterial hypertension. Due to frequent bronchitis, children often develop bronchiectasis.
Keel-like deformity of the chest in children is usually not accompanied by serious functional impairment, therefore the main manifestation of the pathology is a cosmetic defect – protrusion of the sternum forward. The degree of chest deformity in children may progress with age. If you change the position and shape of the heart, there may be complaints of fatigue, palpitations and shortness of breath.
Schoolchildren with chest deformities are aware of their physical disability, try to hide it, which can lead to secondary psychic accretions and require help from a child psychologist.
Poland syndrome or a rib-muscular defect includes a complex of defects, including the absence of pectoral muscles, brachydactyly, syndactyly, amastia or atelium, rib deformity, the absence of axillary hair growth, a reduction of the subcutaneous fat layer.
Cleft of the sternum is characterized by its partial (in the area of the handle, body, xiphoid process) or total cleavage; while the pericardium and the sternum-covering skin are intact.
Diagnosis of chest deformities in children
Physical examination of a child by a pediatrician reveals a visible change in the shape, size, symmetry of the chest; detect functional heart murmurs, tachycardia, wheezing in the lungs, etc.
Often, when examining children with deformities of the chest, various diembriogenetic stigmas are identified: hypermobility of the joints, nystagmus, gothic palate, etc. The presence of objective signs of chest deformity requires an in-depth instrumental examination of children under the guidance of a thoracic surgeon or children’s orthopedic traumatologist.
The degree and nature of the chest deformity in children is determined using thoracometry, which gives an idea of the depth and width of the chest, its oblique dimensions, the thoracic index, and also allows us to trace these indicators over time. More accurate information is obtained after radiography and CT of the chest, sternum, ribs, spine. These studies allow us to assess the bone structure of the chest, changes in the lungs, the degree of displacement of the mediastinal organs.
To determine the severity of secondary changes in the cardiopulmonary system, electrocardiography, echocardiography, cardiac MRI, spirometry, and consultations with a pediatric pulmonologist and pediatric cardiologist are performed.
Treatment of chest deformities in children
Treatment of keeled chest deformity in children begins with conservative measures: exercise therapy, massage, therapeutic swimming, wearing special compression systems, and children’s orthoses. Surgical correction of the keeled thorax is indicated for a pronounced cosmetic defect and progression of the degree of deformity in children over 5 years of age.
Different methods of thoracoplasty include subperichondral resection of the parasternal parts of the ribs, transverse sternotomy, movement of the xiphoid process and subsequent fixation of the sternum in the normal position by stitching it with the perchondrium and the ends of the ribs.
In the case of a funnel chest, conservative measures are indicated only with degree I of deformation; at II and III degrees surgical treatment is necessary. The optimal period for surgical correction of a funnel chest is the age of children from 12 to 15 years. In this case, the fixation of the corrected position of the anterior part of the chest can be carried out with the help of external sutures from metallic or synthetic threads; metal clamps; bone auto- or allografts left in the chest cavity, or without their use.
Special thoracoplasty techniques are proposed for the surgical correction of the sternum cleft and rib muscular defects.
The results of the reconstruction of the chest in children with its congenital deformity are good in 80-95% of cases. Relapses are observed with inadequate fixation of the sternum, more often in children with dysplastic syndromes.
Thoracic deformities in children – congenital or early acquired curvature of the sternum and ribs articulated with it. Chest deformities in children are manifested by a visible cosmetic defect, disorders in the activity of the respiratory and cardiovascular systems (dyspnea, frequent respiratory diseases, fatigue). Diagnosis of chest deformity in children involves carrying out thorakometry, radiography (CT, MRI) of the chest, spine, sternum, ribs; functional studies (FER, EchoCG, ECG). Treatment of chest deformity in children can be conservative (exercise therapy, massage, wearing an external corset) or surgical.
Thoracic deformities in children is a pathological change in the shape, volume, and size of the chest, leading to a decrease in sterno-vertebral distance and disturbance of the position of internal organs. Chest deformities occur in 14% of the population; at the same time, children (mostly boys) congenital anomalies are diagnosed with a frequency of 0.6-2.3%. Chest deformities in children are a cosmetic defect that can cause functional problems with breathing and cardiac activity, and cause psychological discomfort to the child.
These circumstances adversely affect the harmonious development of children and their social adaptation. The problem of chest deformities in children is relevant for thoracic surgery, pediatric traumatology and orthopedics, pediatric cardiology, and child psychology.