Pectus Excavatum Symptoms: 12 Signs, From Mild to Severe

You’ve noticed a dip in your chest, or a symptom, and want to know whether the two are connected.

For many people, the dip is the only sign. When pectus excavatum does cause symptoms, they mostly show up during exercise, not at rest. In a 2024 survey of 432 adults referred for surgery at Mayo Clinic Arizona, with a median Haller index of 4.2 and no comparison group, symptoms tracked chest depth only weakly.

The Haller index is a severity number from a chest scan, where about 2.5 is average. People referred for surgery skew toward deep, symptomatic chests, so I’ll call that survey the Mayo Arizona referral group. Its first author discloses royalties from the maker of the Nuss bar.

I was diagnosed with pectus excavatum at 15 and corrected it without surgery over about three years. The change was visible and measurable, but not complete. I’m not a doctor, so every medical point here comes from a study or hospital source.

Worried right now? Skip to when to see a doctor. Parents of young children should start with sunken chest in babies and children. Causes and treatments are in my main guide to pectus excavatum.

The 12 signs at a glance

Sign	What the research shows	Who it was measured in
1. A dip in the breastbone	Often the only sign. Can deepen at puberty	Hospital patient pages
2. Lower ribs that stick out	May flare at the bottom of the ribcage	Hospital patient page
3. Rounded shoulders	Changes how deep the dip looks, not how deep it is	Hospital patient page
4. Breathless with exercise	Over 80% reported restricted breathing. Test changes start above an index of about 3.25	Mayo Arizona referral group; 99 mostly young patients
5. Less stamina	86% couldn’t keep up with peers; 67% had reduced stamina	Mayo Arizona referral group; 375 surgical patients at UCLA
6. Tiredness	88%	Mayo Arizona referral group
7. Chest pain	About 88% to 90% in one group, 8% in another	Mayo Arizona referral group; 375 surgical patients at UCLA
8. Palpitations	66%	Mayo Arizona referral group
9. Dizziness or fainting	67% dizzy on standing. Fainting is rare	Mayo Arizona referral group; case reports
10. Wheeze with exercise	32% had an asthma diagnosis; lung tests fit asthma in 3	Mayo Arizona referral group
11. Frequent chest infections	32%	375 surgical patients at UCLA
12. Worry about how your chest looks	80% bothered by it; 60.5% had mental health problems before surgery	Mayo Arizona referral group; 266 surgical patients in Beijing

Signs 1 to 3 are things you see. Signs 4 to 12 are things you feel, and nearly every number behind them comes from people with chests severe enough to see a surgeon.

Signs you can see

1. A dip in the breastbone

The main sign is a dip in the lower part of the breastbone (sternum). Mayo Clinic’s symptoms page says that for many people, a slight dip is the only symptom. It can be shallow enough to see only in side light, or deep enough to look scooped out, and it often deepens during the puberty growth spurt.

2. Lower ribs that stick out

Mayo Clinic says the lower ribs may flare out, so the bottom edge of the ribcage pokes forward below the dip. Note the word “may”. You’ll read online that almost everyone with pectus has flared ribs, and I couldn’t find a study showing that. It has its own guide: flared ribs.

3. Rounded shoulders and a hunched look

Mayo Clinic also notes that many people with pectus excavatum have rounded shoulders and a forward-hunched posture.

Posture didn’t cause your pectus. It changes how deep the dip looks, not how deep it is. Slump and it looks worse, stand tall and it looks shallower, and the breastbone hasn’t moved. My pectus posture guide has a two-minute check and a daily routine.

Symptoms you might feel

The 2024 Pectus Care Guidelines, a consensus from specialist surgical and Marfan societies, describe most cases as mild and well tolerated. A small number of people are physically limited, and symptoms at rest are rare, limited to extreme cases.

The surprise is how loosely symptoms follow depth. In the Mayo Arizona referral group, the total symptom score correlated with the Haller index at r = 0.16, where 0 means no relationship and 1 a perfect one. The digestive and emotional sections didn’t track it at all. So a deep chest doesn’t guarantee symptoms, and a mild one can still have some.

4. Shortness of breath when you exercise

Cleveland Clinic lists shortness of breath with exercise first among the physical symptoms. In the Mayo Arizona referral group, more than 80% reported restricted breathing in normal activity and exercise.

In a small study of 13 people with pectus and 20 without, the pectus group had lower peak oxygen uptake (the standard measure of aerobic fitness) cycling sitting up, and near-normal results lying down. The authors put it down to the heart filling less when upright.

Breathlessness at rest or with light effort is a red flag. More in pectus excavatum and shortness of breath.

5. Less stamina than people your age

Cleveland Clinic lists less stamina than peers, and Mayo Clinic a loss of endurance that gets worse over time. In the Mayo Arizona referral group, 86% couldn’t keep up with peers and 83% reported losing endurance. In a 30-year series of 375 surgical patients at UCLA, average Haller index 4.65, 67% had reduced stamina and endurance. If you used to keep up and now can’t, tell a doctor.

6. Tiredness during activity

Cleveland Clinic lists fatigue, and Mayo Clinic extreme tiredness during physical activity. In the Mayo Arizona referral group, 88% reported fatigue.

Note Mayo’s “during activity”: as with signs 4 and 5, effort is usually what brings symptoms out.

7. Chest pain

Both hospitals list chest pain. In the Mayo Arizona referral group, a symptom survey, about 88% to 90% reported it. In the UCLA series, a look back through surgical records, it was 8%. Both groups had severe chests, so the gap says more about how each study asked than about your odds.

Don’t assume chest pain is the pectus. In one case report, a 23-year-old with a severe sunken chest and chest pain turned out to have a 10 cm swelling of the main artery leaving the heart (an aortic aneurysm) and a badly leaking valve. Surgeons repaired the aorta and left the chest alone.

Chest pain is a red flag. Chest wall pain has its own guide: pectus excavatum pain.

8. Palpitations or an irregular heartbeat

Palpitations means noticing your heartbeat racing, pounding, fluttering or skipping. Cleveland Clinic lists palpitations and an irregular heartbeat, and 66% of the Mayo Arizona referral group reported palpitations.

Palpitations that won’t stop, or that come with chest pain, breathlessness or feeling faint, are an emergency. The heart tests worth asking for are in pectus excavatum and heart problems.

9. Dizziness or fainting

Mayo Clinic lists fainting or dizziness, and 67% of the Mayo Arizona referral group reported dizziness on standing up.

Fainting from pectus is rare, but documented. An 18-year-old woman with a severe chest fainted in the shower. Her doctors blamed her breastbone pressing on the right side of her heart, together with low iron and the change of position, and referred her for surgery. In another case, a 19-year-old with a severe chest fainted and went into a dangerous heart rhythm while bending forward. He did well after repair.

Two people, not a pattern, but fainting or nearly fainting always means a doctor first.

10. Wheezing during exercise

Mayo Clinic lists a high-pitched whistle when breathing, triggered by exercise. It can get labelled as asthma. In the Mayo Arizona referral group, 32% said they’d been diagnosed with asthma, yet the authors found lung tests consistent with asthma in only 3 patients.

If you were told you have exercise asthma, it’s fair to ask whether lung function tests confirmed it. More in pectus excavatum and asthma.

11. Frequent chest infections

Mayo Clinic lists frequent upper-airway infections, and 32% of the UCLA surgical patients had frequent respiratory infections. Nobody has shown why, and I couldn’t find a study showing pectus weakens the immune system.

12. Worry about how your chest looks

This is a real symptom, not vanity. Cleveland Clinic lists embarrassment, self-esteem issues and depression, and University of Utah Health notes that even mild cases can cause self-esteem problems.

In the Mayo Arizona referral group, 80% were bothered by how their chest looked, 68% avoided situations where it would show, and 65% each reported anxiety and depression. In a small study of 56 patients, children over 11 showed more embarrassment and social anxiety than younger ones. Among 266 people having the Nuss procedure in Beijing, average age 19, 161 (60.5%) had mental health problems before surgery. A year after surgery many had improved, but 29.7% still had problems.

More in how pectus excavatum affects mental health. If your mood is low, talk to a doctor.

Mild pectus excavatum: what it looks like and what it means

What counts as mild

On the Haller index, about 2.5 is average and 3.25 or more is usually called severe. Below that, there’s no agreed line between mild and moderate. A 2026 CT study of 37 adolescents labelled 2.0 to 3.2 mild, 3.2 to 3.5 moderate and above 3.5 severe, but that’s one study’s labels, not a standard.

A Haller index needs a scan, so a ruler reading isn’t one. At home, measure your dip the same way every month and take photos to see whether it’s changing, as I explain in measuring pectus excavatum at home. If you have a scan, the Haller index explains the number.

Can a mild chest still cause symptoms?

It can, but the evidence points to fewer effects. Scotland’s national Chest Wall Service says that in mild cases there’s no obvious effect apart from how the chest looks. Utah says some people get breathlessness or pain that comes and goes.

Exercise testing agrees. In a German study of 99 otherwise healthy patients, mostly young, results on a cardiopulmonary exercise test (you cycle or run while your breathing and heart are measured) only began to differ as the index rose. Heart rate at the anaerobic threshold was higher above 3.25. Peak oxygen uptake dropped only above 4.0.

Because depth predicts symptoms so loosely, symptoms in a mild chest still deserve a check, not a shrug.

Is mild pectus excavatum dangerous?

For most people, no. University of Utah Health says mild cases aren’t dangerous, even if left untreated. Its pediatric surgeon, Dr. Katie Russell, says that with a mild case that doesn’t bother you substantially, “you can absolutely live a normal life without doing anything about it”. Cleveland Clinic adds that mild cases don’t need surgery. The red flags still count with a mild chest, though. If one applies, get checked anyway.

Will it get worse?

It can, especially while you’re growing. Surgeons at a large US center describe pectus progressing slowly through childhood, then often deepening quickly at puberty. After that it varies: Mayo Clinic says some dips keep deepening into adulthood, and Cleveland Clinic says symptoms can increase over time. That’s the reason to measure monthly through your teens. More in does pectus excavatum get worse with age.

What you can do about a mild chest

Leaving a mild, symptom-free chest alone is a legitimate choice. If you want to work on it:

• Training, breathing and posture. The same surgeons recommend deep breathing, posture work and aerobic exercise for mild to moderate cases. These change how your chest sits and looks, not the breastbone’s depth. In a 2026 controlled trial in 35 teenagers, not randomized, adding a posture programme to the vacuum bell improved posture and pectus-related quality of life, but not the severity of the dip. These pectus excavatum exercises are a good start.
• A vacuum bell. A suction cup that lifts the breastbone while it’s on. Across five published studies, mostly retrospective and mostly in children, an excellent or complete correction happened in 11% to 29% of patients. Results were better with younger age, a shallower dip, a flexible chest and more hours of use. The full numbers are in vacuum bell therapy.

Daily bell use plus structured training is the route I took. That’s one person, not a study.

Other symptoms people ask about

Where I couldn’t find a study, I say so. That doesn’t prove there’s no link, only that nobody seems to have measured it. Dizziness is under sign 9.

Acid reflux and trouble swallowing

In the Mayo Arizona referral group, about 48% reported difficulty swallowing, and 52% got breathless after meals. A 2017 letter in a surgery journal is titled “Pectus excavatum: a rare cause of dysphagia”, dysphagia being the medical word for trouble swallowing.

I couldn’t find a study measuring reflux or heartburn in people with pectus excavatum. If reflux or swallowing trouble keeps coming back, see a doctor, and don’t assume it’s your chest.

Hiccups and burping

I couldn’t find a single study on hiccups or burping in pectus excavatum. If either keeps bothering you, ask a doctor.

Yawning or not getting a full breath

I couldn’t find a study on yawning either. My guess is that many people asking this mean feeling unable to take a full breath in, and that one is reported. A Dutch study of 42 people over 50 with symptoms described what the authors called “inspiratory obstruction”, a sense of being blocked when breathing in.

Muscle spasms

I couldn’t find a study listing muscle spasms as a pectus symptom. Chest wall pain is a separate question, covered under sign 7.

Getting sick a lot

See sign 11. Frequent chest infections are reported in some severe groups, cause unknown, and I couldn’t find a study showing a weaker immune system.

When symptoms start later, or get dismissed

Cleveland Clinic says that in adults, limits on activity may not be obvious until the late 30s or 40s. In the Dutch study of 42 people over 50, 19 (45%) had serious complaints that began only in their 30s or 40s, and 12 of them had been labelled with “unexplained cardiovascular complaints”. Among older adults whose chest X-rays showed pectus, 32% had symptoms that might come from it, and the authors told doctors to consider it.

In the Mayo Arizona referral group, 75% felt dismissed by doctors, and women reported more exercise and heart limits and were more likely to feel dismissed. In a survey of 331 people with untreated pectus, recruited from an online support group across 47 countries, 46% had physical symptoms every day, and 77% felt their providers could do more about them.

Both groups are self-selected, so their rates can’t be applied to everyone with pectus. Still, if you’ve been told “it’s only cosmetic” and you have symptoms, they deserve a proper look. Be specific with your doctor: describe what happens and when, and ask whether your chest could explain it.

There’s no evidence it shortens your life, according to Cleveland Clinic. For aging, lifespan and work, see pectus excavatum problems later in life, and for women, pectus excavatum in women.

When to see a doctor

See a doctor before you start any device, brace or exercise program if any of these apply to you:

• chest pain
• fainting or nearly fainting
• breathlessness at rest or with light effort
• palpitations or an irregular heartbeat
• a diagnosed heart or lung condition
• Marfan syndrome or Ehlers-Danlos syndrome, or a doctor has raised either
• previous chest surgery
• a Haller index above 3.25 together with symptoms
• symptoms that nobody has checked yet

None of these means you’ll need surgery. They mean someone should look at your heart and lungs before you go further. An index above 3.25 is a common referral threshold, not an emergency.

Call 911 (999 in the UK) or your local emergency number now if you have any of these. Don’t drive yourself.

• palpitations that won’t stop
• palpitations with chest pain, shortness of breath, feeling faint or fainting
• sudden chest pain or pressure that doesn’t go away
• chest pain that spreads to your arm, neck, jaw or back
• chest pain with sweating, feeling sick, light-headedness or breathlessness

That list follows the NHS advice on chest pain and palpitations, as in my heart problems guide.

Who to see. Start with your family doctor. If they find something, or your chest is severe and you have symptoms, ask for a referral to a pediatric or thoracic (chest) surgeon who works with chest wall conditions.

What to do next

Pick the line that sounds like you.

• A mild dip and no symptoms. Measure it monthly and take photos, especially through the growth spurt. For a sense of how significant yours is and which route fits, take my free 1-minute quiz.
• Any red flag above. See a doctor first, before any device or program.
• A severe chest with symptoms. Ask for an assessment with a chest wall surgeon. You still choose what happens next.
• You want to try without surgery. Every non-surgical route is on the pectus excavatum treatment without surgery page.
• You’re the parent of a young child. Start with the children’s guide linked at the top.

Whatever you pick, give it honest time. Structural change takes months and years, not weeks.

Sources

1. Jaroszewski DE, et al. J Thorac Dis. 2024;16(12):8565-81. Read it
2. Pectus excavatum: Symptoms and causes. Mayo Clinic. [cited 2026 Oct 20]. Read it
3. Dunning J, et al. Pectus Care Guidelines. Eur J Cardiothorac Surg. 2024;66(1):ezae166. Read it
4. Pectus Excavatum. Cleveland Clinic. [cited 2026 Oct 20]. Read it
5. Zhao L, et al. J Pediatr. 2000;136(2):163-7. Read it
6. Fonkalsrud EW, et al. Ann Surg. 2000;231(3):443-8. Read it
7. Kim RY, Baker CJ. Cases J. 2008;1:351. Read it
8. Christensen MJ, Foti J. Clin Pract Cases Emerg Med. 2026;10(1):81-4. Read it
9. Moossdorff M, et al. Eur Heart J Case Rep. 2021;5(10):ytab373. Read it
10. Living With Mild Pectus Excavatum. University of Utah Health. [cited 2026 Oct 20]. Read it
11. Einsiedel E, Clausner A. J Cardiovasc Surg (Torino). 1999;40(5):733-6. Read it
12. Luo L, et al. Ann Thorac Cardiovasc Surg. 2017;23(4):175-80. Read it
13. Busquets T, et al. Med Eng Phys. 2026. Read it
14. What is pectus excavatum? Scottish National Chest Wall Service, NHS Scotland. [cited 2026 Oct 20]. Read it
15. Abu-Tair T, et al. Ann Thorac Surg. 2018;105(2):455-60. Read it
16. Nuss D, Obermeyer RJ, Kelly RE. Ann Cardiothorac Surg. 2016;5(5):493-500. Read it
17. Kandemir B, Yagci G, Uysal S, Akkas Y, Erbahceci F. Prosthet Orthot Int. 2026 (online ahead of print). doi:10.1097/PXR.0000000000000545. Read it
18. Kim SY, Jeong JY. J Thorac Cardiovasc Surg. 2017;153(1):217. Read it
19. Kragten HA, et al. Neth Heart J. 2011;19(2):73-8. Read it
20. Winkens RA, et al. ISRN Fam Med. 2013:373059. Read it
21. Eisinger RS, Islam S. Chest. 2020;157(3):590-4. Read it
22. Chest pain. NHS. [cited 2026 Oct 20]. Read it