Pectus excavatum (PE) leads to an inward deformity of the chest wall, whereas Pectus carinatum (PC) leads to an outward deformity of the chest wall. The underlying cause in both cases is unknown. You might think, for example, that patients with PC have an overgrowth of the costal cartilage in the chest, and that the opposite is true with people with PE, however, this is not necessarily true (See here for more details). Both conditions can present with asymmetry, and both conditions can be a clue to another underlying disease process such as Marfans.
Some people can have both PE and PC at the same time. This is known as a mixed-type deformity. The reason why some people can have PE, others have PC, and still others have both, is currently unknown.
As you could imagine, the symptoms of these two conditions also differ. Whereas PE is more commonly associated with physiologic impairment of the heart or lungs, PC is more commonly associated with chest pain. Note that the symptoms can overlap – people with PE can also experience pain, and people with PC can also experience exercise intolerance, for example. Rapid heart rate and difficulty breathing are fairly common symptoms reported in both PE and PC. In both cases, patients often report difficulties with body image or self-esteem.
The approach to repair in PE involves popping the chest out (see Nuss Procedure), whereas the approach to repair in PC involves flattening the chest. This has been done with bracing or surgical techniques.
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