Can pectus carinatum (pectus carinatum) develop later in adolescents?

Pectus Carinatum Development in Adolescents

Yes, pectus carinatum can develop or become more pronounced later in adolescence, particularly during growth spurts and puberty when rapid skeletal growth occurs. 1

Timing and Progression

Pectus carinatum (PC) is a chest wall deformity characterized by an outward protrusion of the sternum and adjacent costal cartilages. The development pattern typically follows these stages:

• Initial presentation: May be subtle in early childhood
• Progression period: Often becomes more noticeable during adolescent growth spurts
• Peak manifestation: Typically occurs during puberty when rapid skeletal growth takes place
• Post-pubertal changes: May continue to progress until skeletal maturity is reached

Risk Factors and Associated Conditions

Pectus carinatum can develop in isolation or in association with:

• Connective tissue disorders such as Marfan syndrome 1, 2
• Osteogenesis imperfecta 1, 2
• Noonan syndrome 2
• Homocystinuria 2
• Morquio syndrome 2
• Family history of chest wall deformities

Clinical Evidence for Late Adolescent Development

Research supports the development or worsening of pectus carinatum during adolescence:

• Studies show that correction with bracing is more rapid in patients prior to achieving Tanner stage IV (4.2 ± 0.9 months) compared to those already at Tanner stage IV (8.0 ± 7.1 months), suggesting that the deformity is actively developing during these stages 3

• The average age for bracing treatment is 14.4 ± 1.9 years, indicating that many cases become clinically significant in mid-adolescence 3

• Patients may present with worsening protrusion during growth spurts, with the deformity becoming more pronounced and rigid as adolescence progresses 1

Management Considerations for Adolescent-Onset PC

For adolescents who develop pectus carinatum:

1. Non-surgical approaches:

   • Bracing therapy: Most effective first-line treatment for adolescents
   • The Calgary Protocol has shown success with continuous bracing until correction (correction phase), followed by nighttime bracing (8 hours/day) until completion of axial growth (maintenance phase) 3
   • Success rates are high (approximately 80%) when patients are compliant with bracing protocols 3

2. Surgical approaches (for severe cases or when bracing fails):

   • Minimally invasive repair techniques using intrathoracic compression 4
   • Traditional open surgical procedures for more complex cases 5

Psychological Impact

The psychological impact of developing pectus carinatum during adolescence should not be underestimated:

• Studies show significant improvement in body self-image after correction 6
• Adolescents with PC often experience disturbed body image, lower self-esteem, and reduced quality of life 6
• The visible nature of the deformity can be particularly challenging during the sensitive adolescent period

Key Considerations for Healthcare Providers

When evaluating adolescents with new or progressing pectus carinatum:

• Monitor chest wall development during routine adolescent check-ups, especially during growth spurts
• Assess for associated conditions that may predispose to chest wall deformities
• Consider early intervention with bracing for mild to moderate cases, as treatment is more effective when initiated earlier in the deformity progression
• Recognize that even late-developing cases in adolescence can be successfully treated with appropriate intervention

Prognosis

With appropriate management, the prognosis for adolescent-onset pectus carinatum is generally good:

• Bracing therapy shows excellent results with compliance, with correction typically achieved within 7.0 ± 7.3 months 3
• Maintenance bracing until skeletal maturity helps ensure long-term durability of correction 3
• Recurrence rates are low when treatment protocols are followed completely 3

The key to successful management is early recognition and intervention, even when the deformity develops or worsens later in adolescence.