Sunken chest in a child: causes
In fact, the exact reason has not yet been established. Some scientists argue that this defect is toxic and infectious in nature. This theory suggests that improper development of the sternum is associated with past or hereditary diseases of the mother.
Another theory is that the cause of the development of the defect may be the unfortunate position of the fetus in the womb, when too much pressure was placed on the unborn baby's chest.
If we talk about neurology, then there are no compelling reasons for the development of this pathology. Ultimately, we came to the conclusion that this problem arises due to a violation of the development of the fetus, or rather, the uneven formation of the bone and cartilaginous structure of the sternum and ribs.
excavatum may not necessarily be congenital; it can also be acquired. Most often, deformation occurs as a result of previous diseases, such as rickets, bone tuberculosis, scoliosis, and chronic lung disease. Injuries or severe burns in the chest area can lead to deformation.
Consequences of a sunken chest in a child
There are three degrees of severity of this pathology, which, to a greater or lesser extent, can lead to disruption of the functioning of internal organs.
- First degree. At this stage, the pathology manifests itself in the form of a small funnel, no more than 2 cm in size. This degree is considered the mildest; at this stage, the deformation of the chest does not displace the heart. The problem has more of an external, aesthetic side.
- Second degree. The funnel in this case can reach a depth of up to 4 cm. At the same time, the heart can shift by 2-3 cm, which already leads to disturbances in the body, in particular in the functioning of the heart and lungs.
- Third degree. And finally, the most dangerous degree of funnel chest is when the depth of the funnel itself is more than 4 cm. With this pathology, the heart is greatly displaced. Of course, in this case the patient experiences extensive disturbances in the functioning of the internal organs.
Chest deformity
15840 March 10
IMPORTANT!
The information in this section cannot be used for self-diagnosis and self-treatment.
In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor. Chest deformation: causes of occurrence, what diseases it occurs with, diagnosis and treatment methods.
Definition
Deformation of the chest is understood as changes in the shape of its bone structures of varying degrees of severity, in some cases manifesting not only as a cosmetic defect, but also leading to functional disorders of the respiratory and cardiovascular systems due to compression and displacement of the organs of the thoracic cavity. The chest is a part of the body formed by the sternum, ribs, vertebrae, and muscles connected to each other through joints.
In other words, the chest is a musculoskeletal frame that protects vital organs from external influences.
The chest changes as a person grows and develops, and in adults its shape and size depend on gender, the development of muscles and respiratory organs, type of activity, and lifestyle. The shape of the chest has several normal variants: flat, cylindrical and conical.
Types of chest deformities
All chest deformities are divided by origin
into congenital and acquired.
Congenital defects include funnel-shaped, keeled, combined chest deformities and more rare developmental defects. Funnel
chest is characterized by recession of the sternum and anterior chest wall. This is the most common deformity - it accounts for about 80% of all deformities (occurs 3 times more often in boys) and in 25% of cases is hereditary.
Funnel chest
Keeled
the chest is enlarged in its anteroposterior part, the sternum protrudes forward in the form of a keel. Occurs with a frequency of 6 to 20%, more often in males.
Acquired
The deformation of the chest can be scaphoid, emphysematous, or barrel-shaped, paralytic, kyphoscoliotic, as well as keeled chest (rachitic).
By shape
Deformations are divided into symmetrical and asymmetrical.
To determine the severity of the deformity, a chest x-ray or computed tomography (CT) scan is performed.
On the radiograph, the ratio of the smallest size between the sternum and the vertebral body to the largest is calculated, which is the Giżycka index. Depending on the obtained value, four degrees of deformation are distinguished. When performing a computed tomography scan, the Haller index (computed tomography index) is determined, which is equal to the ratio of the horizontal distance between the inner part of the ribs to the distance between the sternum and the vertebral body at the place of greatest retraction of the sternum.
By stage
deformations are compensated, subcompensated and decompensated.
With compensated
deformity, the cosmetic defect is insignificant, shortness of breath and rapid heartbeat are not observed.
With subcompensated
deformity, the cosmetic defect is pronounced, there is shortness of breath and tachycardia during physical activity.
With decompensated
deformity, the cosmetic defect is disfiguring, shortness of breath and tachycardia are present at rest.
Possible causes of chest deformation
Congenital deformities of the chest are associated with a genetic abnormality in the development of cartilage and bone tissue, and are also often combined with connective tissue defects (in hereditary diseases: Marfan syndrome, Ehlers-Danlos syndrome, etc.). Some types of deformities can be diagnosed in infancy or early childhood (costomuscular defect, cleft sternum). Others debut and progress during periods of accelerated growth of the body, mainly such leaps occur at the ages of 5–6, 8–10, 13–15 years.
Acquired chest deformities occur as a result of external influences (trauma, burns, surgical interventions, for example, for cardiac pathology) or previous diseases (usually inflammatory or infectious, associated with calcium metabolism disorders).
Diseases that cause chest deformation
Diseases that cause chest deformation and are associated with calcium metabolism disorders include
rickets
.
Rickets is a disease of childhood in which, due to various reasons, polyhypovitaminosis occurs in an intensively growing organism with a predominant decrease in the level of vitamin D - the bones lose mineral density and are deformed as the child grows, the chest takes on a keeled shape. Currently, deformations are less common, because Rickets is recognized in the early stages.
Syringomyelia
is characterized by the presence of a cavity filled with fluid located in the spinal cord . The disease can occur due to impaired development of the embryo, due to birth trauma, spinal cord injury, or obstruction of the outflow of cerebrospinal fluid. The walls of the cavity push aside the surrounding tissues, which consist of nerve cells and pathways of the nervous system. As a result, the innervation of the muscles, including those forming the frame of the chest, is disrupted. In later stages, this can lead to curvature of the spine and the formation of a scaphoid depression on the anterior surface of the chest.
Osteomyelitis
– infectious-inflammatory purulent-necrotic lesion of bone tissue, the causative agents of which can be staphylococci, streptococci, Escherichia coli, etc.
Osteomyelitis of the ribs occurs extremely rarely, more often it is post-traumatic, less often - bacterial, when bacteria enter the bone tissue through the bloodstream or spread through contact (for example, with purulent damage to the lining of the lungs).
In the acute period, symptoms such as an increase in body temperature to 39–40°C, pain, redness, and swelling in the area of the affected rib come to the fore.
Among infectious diseases, tuberculosis
. Not only pulmonary tuberculosis (in later stages), but also bone tuberculosis (sternum, ribs, vertebrae) can lead to chest deformities. The process proceeds according to the type of osteomyelitis, but it is caused by a specific pathogen - Koch's bacillus. With tuberculosis of the ribs or sternum, swelling and pain in the affected area are externally determined. With spinal tuberculosis, the vertebral bodies are affected and destroyed, which is manifested by pain; in the later stages, the spinal column is deformed. The disease is accompanied by an increase in body temperature to 37.2–37.6°C, general malaise, night sweats, lack of appetite, and weight loss.
Emphysema
– a disease in which the walls of the alveoli, the structural elements of the lung tissue, are irreversibly destroyed and lose their elasticity, gas exchange is disrupted and increased airiness of the lungs occurs. Emphysema can occur independently or as a result of obstructive pulmonary disease.
Due to the increased airiness of the lung tissue, the chest increases in volume, as if freezing on inhalation (becomes barrel-shaped).
In diseases of the lungs and pleura
, leading to the formation of connective tissue in them and a decrease in their size, the chest is deformed like a paralytic one - it becomes smaller, flattened, and the intercostal spaces are drawn in on the affected side.
Which doctors should I contact if I have a chest deformity?
An initial assessment of the condition can be carried out by a general practitioner. If there are indications, the patient is referred to specialized specialists, such as a surgeon, orthopedic traumatologist, phthisiatrician, oncologist, psychologist, geneticist, otolaryngologist, etc.
Diagnosis and examinations for chest deformation
Before prescribing treatment, the doctor needs to assess the type and shape of the cosmetic defect, find out when and under what circumstances it occurred.
You should definitely tell your doctor about other symptoms, if any: general weakness and fatigue, episodes of fever, shortness of breath, rapid heartbeat.
If necessary, to assess the condition of internal organs or clarify indications for surgical treatment, the specialist will prescribe additional examination methods: chest x-ray in two projections with calculation of indices, complete blood count with leukocyte count and ESR, general urine analysis, spirography, electrocardiography, echocardiography (EchoCG) computed tomography of the chest and mediastinum, magnetic resonance imaging of the chest.
Symptoms that occur during the development of pathology
In newborn babies, a funnel chest deformity can be expressed only as a small depression. Parents may not even pay attention to it, and only as they grow older can this pathology turn into a serious problem. The only thing that is observed in babies is the so-called “inhalation paradox”, when the chest sinks while the baby cries or screams. Fortunately, according to statistics, the inhalation paradox and sunken sternum disappear in the first month of life in most children. For the rest, in the second month of life there is a significant protrusion of the ribs. When the baby sits up, the ribs put pressure on the rectus abdominis muscles, making the baby appear larger. This symptom is very often confused with the symptoms of rickets. Which makes the problem even worse because they start solving a problem that doesn’t exist. Some children may experience difficulty breathing with whistling. But even with an ECG the problem may not be detected.
If during the first six months of the baby’s life the cavity in the chest increases, it will lead to disruption of the functioning of internal organs, especially the heart and lungs. This is why the baby will be susceptible to frequent colds and acute respiratory diseases and may acquire a chronic form of pneumonia.
The most striking symptoms of the pathology appear after three years. Unfortunately, by this time there are problems with posture; the spine has a bend in one direction or is bent backward.
Symptoms and signs
Deformation of the chest
Deformation of the chest has various manifestations, which depends on the nature, severity of the changes, as well as the age of the child:
- At the age of one month to 3 years, it is difficult to visually identify changes without special tests. Frequent acute respiratory viral infections, which tend to be complicated by pneumonia, should be noted. This is due to the fact that chest deformation affects the functional state of the respiratory organs.
- At the age of 3 to 7 years, various changes in shape can be detected, which are mainly localized in the sternum and have the appearance of depressions. In this case, there is still no disruption of the function of external respiration. The form depends on the type of changes, which are determined in accordance with the modern classification.
- In children over 7 years of age (usually up to 10 years), the deformity is clearly visible to the naked eye. Impairment of the function of external respiration develops, which is manifested by shortness of breath of varying severity. A decrease in the supply of oxygen to the blood (hypoxia) is accompanied by the appearance of a bluish color of the skin and visible mucous membranes, and a “marble” pattern appears. Against the background of severe deformation, the functional state of the heart may suffer, which is accompanied by arrhythmia, an increase or decrease in blood pressure. In this case, chest discomfort often appears in the form of tingling or burning.
The deformation is predominantly manifested by depressions. If the pathological process affects not only the sternum, a depression appears between the ribs of the child. This indicates a deterioration in the functional state of the respiratory system and is an unfavorable prognostic sign.
If a deformity is suspected, the normal/pathology of the chest is determined using an X-ray examination. The image makes it possible to assess the scale of possible changes and select treatment tactics.
A child has a sunken chest: what to do?
As soon as the doctor has made a diagnosis, it is necessary to urgently begin treatment for this disease. While the baby is small and his ribs and chest are mostly cartilage and not bones, then there is a chance to be cured using conservative methods:
- Special therapeutic massage;
- Special breathing exercises;
- Swimming, active exercises in water;
- Wearing a corset.
Of course, the course of treatment will be selected individually, based on the degree of pathology and the patient’s condition. A massage course is prescribed to strengthen muscle tissue, improve blood circulation and accelerate metabolic processes.
One of the most important roles in the treatment of a sunken chest in a baby is played by breathing exercises. It is very important to teach a child of a conscious age to take a “tense breath” (a specialist will teach you how to do it correctly). The child also needs to create aerobic exercise; swimming is suitable for small children; running and cycling are suitable for older children. All this physical activity helps to expand the chest and increase the intercostal spaces.
But if the doctor sees that the disease is developing too quickly and seriously threatens the health and life of the patient, then surgery is prescribed. There are cases when only surgical intervention can help restore the natural position of the chest and prevent further development of the pathology.
There are a number of other indications for surgery:
This is when the deformation is of the third degree, as already mentioned, in this case the obligatory accompanying symptom will be a displacement of the heart and disturbances in the functioning of the internal organs.
A deformation that does not provoke serious disturbances in the functioning of internal organs, but leads to serious psychological disorders of the patient.
With Poland syndrome, when the frame and protective properties of the osteochondral structure of the chest decrease due to deformation.
Congenital clefts in the chest area in children of different ages.
When surgery is contraindicated:
If deformations of the ribs and sternum are accompanied by very severe pathologies of the cardiac, vascular and respiratory systems. The patient has moderate to severe mental retardation.
Surgery is a great chance for recovery. In 95% of cases, children get rid of this disease, and only a small percentage of children require repeated surgery.
A special set of exercises for sunken chest in a child
But let's not scare parents ahead of time. As mentioned above, it is much easier to treat this pathology in newborns; their bone skeleton has not yet formed. There are a number of special exercises that help restore the natural position of the breast or at least prevent further development of the pathology. And so, let's start describing the necessary exercises:
- The baby must be placed on his tummy. In this position, pull the toddler’s legs towards the chest, and then slowly return to the starting position. This exercise must be performed 5-10 times.
- Now turn the baby over on his back, spread his arms to the sides, and then bring them together on his chest and press him. This exercise should also be performed 5-10 times.
- During the day, give your child large, but not too heavy toys to hold. This will work like dumbbells, and the child will gradually strengthen his back muscles on his own.
Parents, you must remember that the success of treating this defect in a child directly depends on your perseverance and systematization of the necessary measures. You must be patient and follow all doctors' orders.
