Pectus carinatum, an anterior protrusion of the sternum or chest wall, is much less frequent than pectus excavatum; 16.7% of all chest wall deformities in the Boston Children’s Hospital experience. The anterior protrusion occurs in a spectrum of configurations often divided into four categories ^] The most frequent form, termed chondrogladiolar by Brodkin, consists of anterior protrusion of the body of the sternum with protrusion of the lower costal cartilages. It is described as appearing as if a giant hand had pinched the chest from the front, forcing the sternum and medial portion of the costal cartilages forward and the lateral costal cartilages and ribs inward. Asymmetric deformities with anterior displacement of the costal cartilages on one side and normal cartilages on the contralateral side are less common . Mixed lesions have a carinate deformity on one side and a depression or excavatum deformity on the contralateral side, often with sternal rotation. Some authors classify these as a variant of the excavatum deformities. The least frequent deformity is the chondromanubrial or “pouter pigeon” deformity with protrusion of the upper chest involving the manubrium and second and third costal cartilages and relative depression of the body of the sternum.

The etiology is unknown. The deformity becomes more prominent with the growth spurt of puberty.
The classic repair is a modified Ravitch which involves resection of the costal cartilages and fracture of the sternum. A recent innovation is the Abramson repair which is a modified Nuss operation. This is a minimally invasive operation which is much more cosmetically acceptable.