How Is Pectus Excavatum Diagnosed Step by Step?
Pectus excavatum (a sunken breastbone) can look very different from one person to another. Diagnosis isn’t just about appearance: doctors evaluate anatomy, symptoms, and how the chest shape may be affecting the heart, lungs, posture, and daily life. The exact work-up depends on age, severity, symptoms, and local clinical practice.
Below is a clear, step-by-step overview of the most common tests and why they’re used.
Step 1: Medical history and symptom check
What happens: Your doctor (often a paediatric, thoracic, or chest wall specialist) will ask about:
- Shortness of breath, reduced exercise tolerance, chest discomfort
- Fatigue, palpitations, frequent respiratory infections
- Posture issues or back pain
- Psychosocial impact (confidence, anxiety, avoidance of activities)
Why it matters: Symptoms help determine whether further functional testing is needed and guide treatment priorities. Importantly, some patients have significant impact even when the indentation appears “mild,” and vice versa.
Step 2: Physical examination (and posture assessment)
What happens: The clinician examines:
- Depth and location of the depression
- Chest symmetry, rib flare, shoulder rounding
- Signs of associated conditions (e.g., hypermobility)
Why it matters: Physical findings help assess severity, identify asymmetry, and decide which imaging and functional tests are most appropriate.
Step 3: Photographs or surface scanning (optional but common)
What happens: Some clinics take standardized photos or use 3D surface scanning.
Why it matters: These tools document baseline anatomy and can help track changes over time or after treatment—especially useful in growing adolescents.
Step 4: Chest imaging to understand anatomy
-
A) Chest X-ray (often first)
What it shows: A general view of chest shape and internal structures.
Why it matters: Quick screening and baseline documentation.
-
B) CT scan (very common for surgical planning)
What it shows: Detailed cross-sectional anatomy of the chest wall, heart, and lungs.
Why it matters: CT helps quantify severity and supports procedure planning. It’s also commonly used to calculate indices (see next step).
-
C) MRI (sometimes used instead of CT)
What it shows: Detailed anatomy without ionizing radiation.
Why it matters: In selected centres/patients, MRI can provide comparable planning information while reducing radiation exposure.
Step 5: Severity measurement (indices)
Clinicians often calculate measurements from CT or MRI to describe severity in a standardized way.
Common examples:
- Haller Index (HI): Compares chest width to the distance between sternum and spine.
- Correction Index (CI): Estimates how much the sternum is displaced compared with a “normal” position.
Why it matters: These metrics support objective assessment, help compare cases, and can contribute to treatment decisions—always combined with symptoms and clinical judgment.
Step 6: Heart evaluation (when indicated)
-
A) Echocardiogram (ultrasound of the heart)
What it assesses: Heart structure and function, and whether the chest shape compresses or displaces the heart.
Why it matters: Helps understand any cardiac impact, especially if there are symptoms like palpitations or reduced exercise tolerance.
-
B) ECG (electrocardiogram)
What it assesses: Heart rhythm and electrical patterns.
Why it matters: Useful if palpitations or rhythm concerns exist, or as part of a preoperative assessment.
Step 7: Lung and breathing tests (when indicated)
-
A) Pulmonary function tests (PFTs / spirometry)
What they assess: Lung volumes and airflow.
Why it matters: Identifies restrictive patterns or breathing limitations that can influence management.
-
B) Exercise testing (sometimes)
What it assesses: How heart and lungs respond to exertion (e.g., cardiopulmonary exercise testing).
Why it matters: Especially relevant for patients who feel limited during sports or physical activity.
How this relates to treatment planning
For patients being evaluated for surgical correction, imaging—often a chest CT scan—plays a key role in determining suitability and planning, because it provides the anatomical detail needed for a safe, controlled approach.
Pectus Up® is designed as a minimally invasive, extrathoracic method (performed outside the thoracic cavity). As with any option, the decision must be made by a qualified surgeon after reviewing the full assessment.
Important note
This information is for general education and does not replace medical advice. Only a qualified healthcare professional can determine which tests are appropriate and whether a specific treatment option is suitable for an individual patient.
