Why is my baby's chest high?

We should take care of children meticulously and have a special understanding of the baby's physical development. But some parents find that their baby has a high chest. What's going on? Medically, there is a concept called pigeon chest deformity, which is caused by excessive growth of rib cartilage. Medically speaking, it is related to incomplete development. Some babies have high chests because of genetics. But no matter what the cause is, you should seek medical treatment.

Genetic

Most people believe that it is caused by overgrowth of ribs and costal cartilage, and that the deformity of the sternum is secondary to the rib deformity. Chest wall deformities that affect breathing and circulation, such as pectus excavatum, pectus carinatum, and pectoralis fissure, in addition to the mental burden and personality impact caused by the deformity, the deformity itself also causes damage to respiratory and circulatory functions and requires surgical correction.

Pathological causes

Pectus carinatum is generally believed to be related to genetics, just like pectus excavatum. Most people believe that it is caused by excessive growth of ribs and costal cartilages, and that the deformity of the sternum is secondary to the deformity of the ribs. Some people believe that it is related to the abnormal development of the diaphragm attachment part. The front part of the diaphragm is underdeveloped. It is not attached to the xiphoid process and the costal arch, but to the back of the rectus sheath. During deep exhalation, the upper part of the rectus abdominis is pulled inward, and the overgrown muscles on the outer side of the diaphragm contract, deepening the Howe's groove, and the lower part of the sternum moves forward due to the lack of diaphragm support, resulting in a pigeon chest deformity. Another group of people believe that pigeon chest deformity is related to recurrent chronic respiratory tract infections. Long-term chronic respiratory tract infections reduce the compliance of lung tissue and weaken respiratory function. In order to meet respiratory needs, the diaphragm movement is strengthened, pulling the Howe groove inward and gradually forming pigeon chest deformity.

Clinical manifestations: Most cases of pigeon chest cannot be found immediately after birth like funnel chest, and are often gradually noticed after the age of five or six. Generally, pigeon chest rarely causes symptoms of heart and lung compression. Severe pigeon chest often causes recurrent upper respiratory tract infections and bronchial wheezing, poor activity endurance, and easy fatigue. More importantly, patients suffer from a great mental burden due to their deformities.

Carinae is the opposite of funnel chest, with the sternum protruding forward. There are generally two types: the first is a normal thorax with a keel-like protrusion, that is, the lower part of the sternum moves forward more significantly than the upper part. The xiphoid process attachment part is often the most prominent, the longitudinal surface of the pectoral muscle is arched, and the 4th to 8th costal cartilages on both sides are deep concave grooves parallel to the sternum, making the protruding part more obvious, as if a giant hand grabbed the sternum and crushed the costal cartilages on both sides. Another type of pigeon chest is relatively rare. The manubrium, upper part of the sternum and costal cartilages of the upper chest protrude forward and upward, while the middle part of the sternum bends backward and the lower part of the pectoral muscle protrudes forward. The sagittal plane of the sternum is in a "Z" shape, and the costal cartilages on both sides are also concave inward. Therefore, some people also call this type of deformity pectus excavatum. Diagnosis and Differentiation: The incidence of pectus carinatum is lower than that of pectus excavatum, and the clinical symptoms are also milder, so it is not taken seriously by patients and their families. Mild cases of pectus carinatum often do not require medical treatment, but severe cases of pectus carinatum have obvious deformity and are easy to diagnose clinically. The lateral chest X-ray can clearly show the deformity of the sternum, and other examination methods often do not find any abnormalities.

Treatment and prevention of pigeon chest also requires surgical methods.

1. The upper and lower vascularized sternal flip surgery are the same as the surgical method for pectus excavatum.

2. The method of sessile sternum rotation surgery is basically the same as that of funnel chest surgery, except that the ribs and costal cartilages of chicken chest are longer. The 3rd and 4th ribs and costal cartilages of chicken chest are the longest, while the 5th rib is relatively short. Special attention should be paid during surgery.

3. Sternocostal depression surgery: Make a median or transverse incision on the chest, separate the pectoralis major muscles on both sides, expose the deformed pectoralis muscles and costal cartilages on both sides, cut the rectus abdominis at its attachment point, turn it downward, incise the rib periosteum, remove the excessive parts of the affected costal cartilages within the deformity, and suture the excessive periosteum longitudinally. If the pectoralis deformity is severe, a transverse wedge osteotomy is also required to flatten the sternum, which is then fixed with steel wire, the pectoralis major muscles are pulled together and sutured, and the rectus abdominis muscles are sutured to the front of the sternum. The result of the operation was very satisfactory.

When correcting pectus carinatum deformity through surgery, attention should be paid to whether the protruding sternum will compress the heart after the surgery. Therefore, the chest X-ray and CT scan should be carefully studied before the surgery. If there is no lung tissue between the sternum and the heart, the sternum may compress the heart after the surgery. The sternum should be appropriately raised during the surgery.