Pectus excavatum, or “hollow breast” in Latin, is a chest wall deformity that is commonly observed in humans and occasionally in veterinary patients. This congenital defect occurs when the caudal ribs and sternum do not develop properly, resulting in a concavity from the 3rd to 5th rib to the xiphoid process. While it is the most prevalent chest wall deformity in both humans and animals, it is relatively rare in the animal kingdom.
The Origins of Pectus Excavatum
The exact cause of pectus excavatum remains unknown. Early theories suggested that factors such as diaphragm hypertension, nutritional disturbances, or increased intrauterine pressure played a role in its development. However, current research indicates that there is a metabolic defect in the sternocostal cartilage that leads to biomechanical weakness and overgrowth. In humans, there is a genetic association, with 43% of patients having a family history. Pectus excavatum is also linked to scoliosis and connective tissue disorders in humans, such as Marfan, Noonan, and Ehlers-Danlos syndromes. In animals, certain breeds, like Bengals and Burmese cats, as well as brachycephalic dogs, such as Maltese and English Bulldogs, have a predisposition to the condition. Additionally, acquired pectus excavatum can occur in both humans and animals due to factors like respiratory obstruction or laryngeal paralysis.
Identifying Pectus Excavatum
Pectus excavatum is present from birth and is detectable in puppies and kittens within a few days. The deformity worsens as they grow, but once growth ceases, the condition does not progress further. Clinical signs can vary, with mild cases often presenting minimal signs or concerns about appearance. However, severe cases can lead to cardiorespiratory compression and worsen with age. Humans may experience dyspnea, chest pain, fatigue, palpitations, tachycardia, and exercise intolerance. In animals, dyspnea is the most commonly observed sign, along with exercise intolerance, inappetence, recurrent respiratory infections, weight loss, coughing, cyanosis, and heart murmurs.
Diagnosis and Treatment
Diagnosing pectus excavatum involves a physical examination, and imaging techniques can help determine the severity of the condition. Anthropometric or clinical indices measure the depth of the defect in comparison to the depth of the thorax. Radiographs provide a visual representation of the deformity and allow for the calculation of different indices to assess the compression of the chest. Surgery is recommended based on clinical signs and the severity of the condition. In humans, non-surgical options such as medication, acupuncture, physical therapy, and the use of a vacuum bell have shown some success in milder cases. However, severe cases or those in older patients require surgical intervention. The two most common surgical procedures are the Ravitch procedure and the Nuss procedure. In veterinary patients, the choice of surgery depends on the animal’s age, with an open approach typically used for older animals and external splints or circumsternal sutures for younger animals. Complications associated with surgery can include puncture of the lungs or heart, pneumothorax, hemorrhage, and re-expansion pulmonary edema.
Pectus excavatum is a treatable condition in puppies and kittens, with surgery offering a favorable prognosis. For the best outcomes, surgery is typically performed between 8 and 12 weeks of age, when the thorax is still compliant, and the patient can tolerate anesthesia. With the right approach and proper care, animals with pectus excavatum can lead happy and healthy lives.
Remember, if you suspect that your pet may have pectus excavatum or any other health concerns, consult a trusted veterinarian for guidance and appropriate treatment options.
Read more about pectus excavatum and animal care at Katten TrimSalon.