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Curriculum in Cardiology
Images

Pectus Carinatum (Pigeon Chest)

A 16‑year‑old boy presented with progressive shortness of
breath on exertion (New York Heart Association class II) for
1 year. He said that there was no fever, chest pain, cough,
palpitations, syncope, or any physical trauma. He had no
significant medical history. He also has no significant family
medical/surgical history. Inspection of the chest showed
marked chest wall deformity [Figures 1 and 2], remainder of
the physical examination was unremarkable. The chest X‑ray
showed hyperinflated lungs; [Figure  3] anterior protrusion
of the sternum and ribs [Figure  4]. His electrocardiogram
[Figure 5] showed the right atrial enlargement and biventricular
hypertrophy. However, his echocardiogram did not reveal
any chamber hypertrophy or valve abnormality, and a
normal ejection fraction. This false hypertrophy on the
electrocardiogram was due to the chest wall deformity. Pectus
carinatum is a deformity of the chest wall characterized by
anterior protrusion of the sternum and ribs. Males are more
commonly affected than females. Pubertal males are the most
common affected patient group, as in this case. Causes are
idiopathic, trauma, following open heart surgery, and excessive
structural abnormalities of cartilage. It is also associated with
several syndromes. There are various orthotic and surgical
procedures to correct the deformity. Treatment included
referral to thoracic surgeons, who advised routine follow‑up
and consideration of surgery if the symptoms worsened. On
follow‑up at 6 months, he is relatively asymptomatic.
Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent forms. In the form the patient(s) has/have
given his/her/their consent for his/her/their images and other
clinical information to be reported in the journal. The patients
understand that their names and initials will not be published
and due efforts will be made to conceal their identity, but
anonymity cannot be guaranteed.

Figure 1: Side view. Figure 2: Frontal view.

Figure 3: PA X-ray. Figure 4: Lateral X-ray.

118 © 2017 Journal of the Practice of Cardiovascular Sciences | Published by Wolters Kluwer - Medknow
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Bhargava and Bhargava: Pigeon chest

Address for correspondence: Dr. Raghav Bhargava,

Department of Medicine, Glan Clwyd Hospital, Bodelwyddan, Wales, UK.
E‑mail: balrambhargava@yahoo.com

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Figure 5: ECG.
DOI:
10.4103/jpcs.jpcs_37_17
Madhav Bhargava, Raghav Bhargava1
PG Registrar Internal Medicine,
Aster Medcity, Kochi, IN 682027, India,
1
Department of Medicine, Glan Clwyd Hospital, How to cite this article: Bhargava M, Bhargava R. Pectus carinatum (Pigeon
Bodelwyddan, Wales, UK Chest). J Pract Cardiovasc Sci 2017;3:118-9.

Journal of the Practice of Cardiovascular Sciences  ¦  Volume 3 ¦ Issue 2 ¦ May-August 2017 119