(keel chest, pigeon chest)

Congenital deformation of the chest characterized by a  forward chondrosternal prominence. The sternum has a particular tipped shape, resembling the keel of a boat. Much rarer than pectus excavatum (1/4000 births) and often associated with other disorders (Marfan's syndrome, heart and/or musculoskeletal abnormalities, scoliosis). It could be caused by an excessive growth of the chondro-sternal cartilage.

There is an even rarer form of sternal protrusion, in the upper part of the sternum, called “pectus arcuatum”.

Treatment may be:

-        orthotic, before puberty: external dynamic compression (braces)

-        surgical: either cartilage removal, or insertion of two metal bars (surgically removed later), to re-shape the sternum as for pectus excavatum. Anesthetic management and postoperative management are similar to those of the funnel chest surgery.

Anesthetic implications:

preoperative echocardiography.

References : 

-        Robicsek F, Watts LT. 
Pectus carinatum. 
Thorac Surg Clin 2010; 20:563-74.

-        Martinez-Ferro M, Fraire C, Bernard S. 
Dynamic compression system for the correction of pectus carinatum. 
Semin Pediatr Surg. 2008;17:194-200

-        Robicsek F, Watts LT, Fokin AA. 
Surgical repair of pectus excavatum and carinatum. 
Semin Thorac Cardiovasc Surg 2009; 21:64-75.

-        Kim S, Idowu O. 
Minimally invasive thoracoscopic repair of unilateral pectus carinatum. 
J Pediatr Surg 2009; 44:471-4.

Updated: November 2018