Chest Wall Program
About the Chest Wall Program
Chest wall anomalies (CWAs) may affect heart and lung function and have profound psychosocial consequences, especially in adolescents. The Cohen Children’s Chest Wall Program for children, adolescents and young adults focuses on the treatment of CWAs such as pectus excavatum and pectus carinatum.
Our pediatric surgeons have special interest and extensive experience in the evaluation and management of these anomalies and a variety of related rare and/or complex disorders. Along with treating many chest wall patients each year, we engage in CWA research and participate in national and international CWA medical conferences.
Our expertise
When a child is referred to our program, we work with their family to determine the best approach to treatment together. Treatment is not always necessary, so the condition is often just observed.
If surgery is required, your child is in the best of hands; in fact, the first minimally invasive procedure for pectus excavatum (known as the Nuss procedure) in New York was performed at our hospital in 2000. Since then, we have become one of the busiest centers for these procedures in the New York region.
If a chest wall abnormality is associated with other medical conditions, such as structural heart disease or Marfan syndrome, we collaborate with other pediatric specialists—such as cardiologists, pulmonologists and geneticists—to provide comprehensive care. We work closely with our colleagues in pediatric anesthesia, child life and nursing to develop each patient’s personalized treatment plan from well before the day of surgery to after the patient is discharged from the hospital.
Additional consultations with our associated specialists are arranged as needed, including:
Conditions we treat
Pectus excavatum and pectus carinatum are the most common chest wall anomalies; we see many patients with these conditions each week. We also treat a number of patients with more unusual and/or complex conditions, including:
- Mixed pectus anomalies
- Absent, fused or malformed ribs
- Thoracic outlet syndrome/cervical rib
- Abnormalities of the sternum and clavicle (breastbone and collar bone)
- Chest wall tumors
- Chest wall anomalies with scoliosis
- Thoracic insufficiency syndrome (TIS)
- Poland syndrome
- Chest wall anomalies associated with connective tissue disorders
- Jeune, Charcot-Levin and other chest wall growth syndromes and conditions
- Breast asymmetry associated with chest wall anomalies
FAQ
What is a chest wall anomaly?
Chest wall anomalies (or deformities) refer to conditions in which the chest wall is abnormally formed. Two of the most common abnormalities are pectus excavatum, where the sternum or breastbone is depressed inward, and pectus carinatum, where the front of the chest bows outward. These abnormalities are quite common and are often asymptomatic, but may cause intermittent episodes of chest pain, shortness of breath with exertion and exercise intolerance.
How common are chest wall anomalies?
You are not alone! Up to one in 400 people have a CWA. While this might not sound like a lot, it is a very common congenital anomaly (a deformity from birth). Given the U.S. population, this means almost a million people in the nation could have a CWA.
Do all CWAs need to be repaired?
Some CWAs are mild and do not need correction, but many should be repaired since they affect health. It is best to have a full evaluation by a physician with special expertise in CWAs before deciding not to pursue treatment, even if it appears mild.
Does correcting a CWA always involve surgery?
No. Though all core members of the Cohen Children’s Chest Wall Program are pediatric surgeons, only a small number of patients we evaluate actually require surgery. When surgery is necessary, we favor minimally invasive procedures, such as the Nuss procedure.
What causes chest wall anomalies?
No one really knows. It's thought that excessive growth of the central part of the ribs (which are made of cartilage rather than bone) causes the chest wall to buckle. This either forces the sternum (breastbone) inward—causing a excavatum, or outward—causing a carinatum.
Why didn't we notice a chest problem until my child became a teenager?
This is not uncommon. CWAs tend to surface during puberty, especially during the teenage growth phase. The chest wall may seem completely normal before these ages. However, In some cases, the abnormality can be noticed as early as infancy.
My child has scoliosis as well as pectus. Is that common?
Yes. Scoliosis (curvature of the spine) is associated with CWAs. It does not seem that one causes the other, but rather that there is an underlying genetic abnormality which predisposes to both. If both a CWA and scoliosis are present, we will coordinate care with your orthopedic spine surgeon.
At what age should a person with a CWA be evaluated by a surgeon?
A CWA should be evaluated as soon as it is noticed. Even if a child is young and no immediate intervention is planned, a complete evaluation will provide a clear picture of the problem and may uncover related health issues. Counseling at that time will provide detailed information specific to the individual, including what to expect in the future and what type of heath monitoring may be necessary.
Should I have some testing done before my first appointment?
If any relevant testing has been done, you should bring those results with you to your first visit. However, we do not advise specifically getting any testing done before your visit.
Our team
