Pectus excavatum (PE) is a chest wall deformity that can present with physical or psychosocial symptoms, or none at all. So which physician should you see if you have questions about your Pectus?
If it’s your first time, start with a primary care physician, whether that’s a pediatrician or a general internal or family medicine physician. Even if you know you have PE, and you think you’re ready to talk to a specialist, it’s very important to see a primary care physician first. PE is most commonly an isolated condition, can be associated with many other syndromes or diseases, such as Marfan’s, Poland’s, and others. These primary care physicians are well-suited to screen for these other conditions. Your primary care physician will also act as your advocate and team leader, if you end up seeing other specialists and need help synthesizing together all the information.
If your primary care physician has a concern for another co-existing condition in addition to your PE, they may send you to a geneticist.
Next, if you’re PE is moderate to severe, your primary care physician should send you to a cardiologist and a pulmonologist. Standard assessments in the evaluation of PE include an echocardiogram (heart ultrasound imaging) and pulmonary function tests (breathing exam). If you’ve already seen a primary care physician, and you’re insurance lets you see specialists without referrals, this would be the next step.
Don’t forget about possible psychosocial issues. If you additionally feel that psychosocial symptoms related to your PE (e.g., poor body image, low self-esteem, depression, etc) play a role in affecting your quality of life, it is especially important to be seen by a psychiatrist or similar psychologist. This is an often overlooked aspect of PE but can be an important factor in the decision-making process regarding getting treatment.
Finally, if your PE is moderate to severe, and there are concerning symptoms, regardless of your age, and you would be willing to learn more about surgical treatment, see a surgeon. Most commonly this will be a pediatric surgeon, even if you’re an adult. However you may consider seeing an orthopedic surgeon or a plastic surgeon. The surgeon can teach you about your options for treatment, but they will want to see results from physiological assessments (i.e., cardiologist and pulmonologist) to help you make an informed decision.