Pectus excavatum and pectus carinatum are the most common congenital chest wall deformities, yet their clinical significance is frequently underestimated. Often regarded as primarily cosmetic conditions, they may have important cardiopulmonary, functional and psychological consequences, particularly during the adolescent growth spurt.



This presentation aims to improve the recognition, assessment and management of pectus deformities, with particular relevance to general practitioners and physicians. It will explore the natural history of these conditions, their association with connective tissue disorders, and the potential progression of chest wall deformity during adolescence. Clinical features warranting further investigation include exercise intolerance, disproportionate breathlessness, chest pain, fatigue, palpitations and significant body image disturbance.



The appropriate assessment of patients will be discussed, including clinical examination, CT-derived Haller and correction indices, pulmonary function testing, echocardiography and cardiopulmonary exercise testing where indicated. The presentation will review contemporary treatment options, from observation, vacuum bell therapy and external bracing to minimally invasive surgical correction, including the Nuss and Abramson procedures, and selected open surgical techniques.



Particular attention will be given to the optimal timing of intervention, the importance of individualising treatment according to age, symptoms, chest wall flexibility and deformity severity, and the potential consequences of overly aggressive early surgery on thoracic growth. The South African experience will provide a practical clinical perspective on patient selection, referral and access to treatment.



The central message is that pectus deformities should not be dismissed as cosmetic abnormalities. Early recognition, appropriate investigation and timely referral can help identify patients who may benefit from treatment and support better functional, psychological and quality-of-life outcomes.



Learning objective: To equip clinicians to recognise clinically significant pectus deformities, identify indications for investigation and referral, and understand the available treatment options and principles governing the timing of repair.