Congenital Chest Wall Deformities in Children: A Narrative Review

Abstract

Highlights What are the main findings? Chest wall deformities in children span a wide spectrum—from pectus excavatum and carinatum (affecting ~1% of children) to rare, life-threatening anomalies—and are best understood as a genetically heterogeneous, mostly multifactorial group with clinically important syndromic associations rather than isolated cosmetic conditions. The most reproducible benefit of treatment lies in improved body image, self-esteem and quality of life, which are largely independent of anatomical severity, whereas a generalizable cardiopulmonary benefit of surgical correction remains unproven. What are the implications of the main findings? Conservative remodelling (vacuum bell and dynamic compression bracing) should be first-line in suitable children, with minimally invasive, hybrid and modified-Ravitch surgery reserved for complex morphology. Surgical indications should integrate psychosocial burden alongside anatomical criteria, and early-onset deformity should prompt genetic referral and cardiovascular surveillance for associated connective-tissue disorders. Abstract Congenital chest wall deformities encompass a broad spectrum of anomalies, from the common pectus excavatum and pectus carinatum to rare, life-threatening conditions such as sternal clefts, ectopia cordis, pentalogy of Cantrell, and asphyxiating thoracic dystrophy (Jeune syndrome). This narrative review synthesizes current evidence on their epidemiology and pathogenesis, genetics and syndromic associations, diagnostic assessment, and the full range of conservative and surgical management, with particular attention to developments of the past decade. Pectus deformities affect roughly 1% of children, and although familial clustering supports a genetic contribution, no single causative gene has been established; syndromic associations, especially connective-tissue disorders, remain clinically actionable and warrant cardiovascular surveillance. Conservative treatment has become first-line for suitable patients: the vacuum bell for pectus excavatum and dynamic compression bracing for pectus carinatum both achieve good results when compliance is maintained. Minimally invasive repair remains the surgical standard for pectus excavatum, complemented by the modified Ravitch and hybrid procedures for complex morphology, while emerging innovations and enhanced-recovery protocols continue to improve safety and recovery. The rarer midline and chondrodysplastic deformities demand individualized, often emergency, multidisciplinary care. Across the spectrum, the most reproducible benefit of treatment lies in body image, self-esteem and quality of life, whereas a generalizable cardiopulmonary benefit remains unproven. Management should be individualized to the deformity, the child’s physiology, and the psychosocial burden of disease.