What’s a funnel case?

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Funnel chest is a congenital chest anomaly in which the center of the chest is depressed, rather than protruding. Many cases are mild and do not create problems other than aesthetic discomfort for the patient. In others, the sunken chest puts pressure on the heart and lungs, creating breathing difficulties and heart problems. Surgery is available to treat this condition, although it is usually only considered an option in cases where the patient has health problems.

Known formally as pectus excavatum, funnel chest can appear on its own or in association with another congenital condition such as Marfan syndrome. It is caused by excess growth of connective tissue around the chest, pulling the center of the chest down. Mild cases often resolve on their own, with the child’s chest gradually growing outward with time. Other patients may have a severe funnel chest, and as the name suggests, the deformity sometimes really looks like a funnel planted in the middle of the chest.

People who are having trouble breathing, can’t exercise, or have heart problems may be evaluated for surgery. Medical imaging studies may be done to see if the depressed breastbone is pressing on the contents of the chest cavity. Historically, the procedures were very invasive and required reconstructive surgery on the chest. Today, many patients have a less invasive surgery known as a Nuss procedure, in which a stabilizer bar is inserted through the side of the chest and flipped over to push the breastbone out. After several years, the bar can be removed and the chest should remain stable.

This musculoskeletal disorder can sometimes cause patients to be dissatisfied with the physical appearance of the chest, although there is no impairment of function. For these patients, milder surgery may be offered as an option to correct the appearance of the chest, without the invasive and painful options involved for patients with severe funnel chest. A surgeon can discuss the risks and benefits with a patient to make a decision on the best treatment option.

Recovery from funnel chest surgery is long, regardless of the procedure used. Patients usually spend several days on bed rest, have to do breathing exercises to strengthen their lungs, and are required to limit their physical activities for weeks or months. Patients preparing for surgery should discuss aftercare thoroughly so they know what to expect before the surgery takes place.

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