Pectus Excavatum ICD-10: Causes, Symptoms, Diagnosis

Key points

• In ICD-10 and ICD-10-CM, pectus excavatum is coded Q67.6, within the chapter for congenital musculoskeletal deformities; the neighbouring code Q67.7 covers pectus carinatum, the opposite, protruding shape.
• It is the most common anterior chest wall difference, making up roughly nine in ten of them, and affects about 1 in 400 births, more often boys, with reported male-to-female ratios from about 2 to 1 up to 5 to 1.
• The cause is congenital: the costal cartilage that joins the ribs to the breastbone grows in a way that pulls the sternum inward. It is not caused by posture or diet, and a familial component is reported in roughly a third to just under half of cases.
• For most people it is a structural and cosmetic difference, though a minority develop breathlessness, chest pain, palpitations or reduced exercise tolerance and need cardiac and pulmonary assessment.
• Severity is graded on a scan using the commonly used bands: below 3.2 for mild, 3.2 to 3.5 for moderate and above 3.5 for severe, with 3.25 the long-standing surgical threshold. These bands read from the Haller index, the ratio of chest width to depth at the deepest point.
• The correction index is an alternative measure that stays accurate in unusually shaped chests, and St. Peter and colleagues reported that a value of 28 percent or more corresponds to the same 3.25 threshold.

The short answer, expanded

Pectus excavatum, sometimes called funnel chest or sunken chest, is the most common difference in how the front of the chest is shaped. In the tenth revision of the International Classification of Diseases, it has its own diagnostic code, Q67.6, which sits in the chapter for congenital malformations and deformations of the musculoskeletal system. The clinical modification used in the United States, ICD-10-CM, uses the same code. A code is a label for records and billing. It is not a measure of how severe a chest is or what treatment it needs.

The physical difference is straightforward to describe. The ribs join the breastbone through flexible cartilage. In pectus excavatum that cartilage grows in a way that pulls the sternum backward, leaving a depression in the centre of the chest that can be shallow or deep, and symmetrical or one-sided. It is usually present from birth or early childhood, and it very commonly becomes more pronounced during the growth spurt of adolescence.

For most people it is a structural and cosmetic difference rather than a danger. A minority develop symptoms that deserve proper assessment. Diagnosis is clinical first, then confirmed and graded on imaging. The sections below work through what causes it, what symptoms to watch for, and how it is measured.

What the evidence actually shows

The ICD-10 code and what it covers

Pectus excavatum is coded Q67.6. The Q chapter of ICD-10 covers congenital malformations, deformations and chromosomal abnormalities, and the Q67 block covers congenital musculoskeletal deformities of the head, face, spine and chest. Q67.6 is the specific entry for pectus excavatum. The neighbouring code Q67.7 is pectus carinatum, where the sternum protrudes rather than sinks, which is a separate condition with a separate management path. The code is a record of the diagnosis only. It does not encode severity, the depth of the depression, or whether symptoms are present, so two people with the same label can have very different chests and very different needs.

What causes it

Pectus excavatum is a congenital difference in how the costal cartilage, the cartilage that connects the ribs to the breastbone, grows. It is not caused by posture, diet, or how a child was carried or held. It is the most common anterior chest wall difference, accounting for roughly nine in ten of them. Reported incidence ranges from 1 in 300 to 1 in 1,000 live births depending on the series, and 1 in 400 is a reasonable working figure. It is more common in boys, with published male-to-female ratios ranging from about 2 to 1 up to 5 to 1. A familial component is reported in a large share of cases, roughly a third to just under half, so a chest that runs in a family usually has a genetic explanation rather than anything a parent did. Severity commonly changes during periods of rapid growth, which is why a chest that looked mild at eight can look more marked at thirteen.

The symptoms that matter

For most people pectus excavatum does not threaten health, and there is no good evidence that a mild, symptom-free chest shortens life or causes progressive damage. A minority do develop symptoms, and those deserve to be taken seriously rather than dismissed as anxiety or being unfit. The features to watch for are breathlessness out of proportion to the activity, chest pain, palpitations, unusual fatigue, and a person who quietly stops keeping up in sports they used to manage. In moderate and severe cases the sternum can sit against the heart and reduce the room the lungs have to expand, which is the mechanism behind the cardiac and pulmonary symptoms that are sometimes reported. Anyone with those features should be assessed by a physician, usually with an echocardiogram and lung function testing, before any treatment is chosen. That assessment is a medical step, and it comes before any decision about devices or surgery.

How it is diagnosed and graded

Diagnosis begins with a clinical examination. A physician can recognise pectus excavatum on sight and by palpation, and can judge how flexible the chest wall is by watching whether the sternum lifts. The diagnosis is then confirmed and graded on imaging, and two measurements come up most often.

The first is the Haller index, which divides the transverse width of the chest by its depth at the deepest point of the depression, measured on a CT or MRI scan. A chest without pectus excavatum sits at around 2.5. Commonly used bands run below 3.2 for mild, 3.2 to 3.5 for moderate, and above 3.5 for severe, and 3.25 has long been the threshold at which surgical repair is considered.

The second is the correction index, which many centres now use because it stays accurate in unusually shaped chests where the Haller index can mislead. It expresses the depth of the depression as a proportion of the total chest depth. St. Peter and colleagues reported that a correction index of 28 percent or more corresponds to the same 3.25 threshold, and that the Haller index overlaps between people with and without pectus excavatum about half the time, while the correction index separates the two groups more cleanly. One practical note: CT uses ionising radiation, and many centres now take the same measurements with MRI instead, so asking whether MRI is an option is a fair question.

Who this works best for

A diagnosis is the start of a treatment decision, not the end of one, and the code on its own does not point to a treatment. For patients considering the non-surgical vacuum bell route, the published predictors of a good response are consistent enough to state directly. Age is the strongest single influence on the outcome, because younger cartilage has not begun to stiffen and responds more readily to sustained gentle pressure. A shallow to moderate depth, a flexible chest wall where the sternum visibly lifts under suction, and consistent daily use over one to two years all improve the odds. Adolescents and adults with a flexible chest can still respond, but timelines are longer, and the pioneer cohorts included patients well into adulthood (Haecker 2016).

Who this does not work for

The same diagnosis can point away from a home device entirely. A vacuum bell will not help a rigid chest wall where the sternum does not visibly lift under suction, because the mechanical precondition is simply absent, and time does not change that. A deep, long-standing, ossified chest in an adult is a poor target for gradual remodelling and is usually a surgical conversation. People who cannot use a device consistently, daily for a year or more, are the largest single failure group in the literature. Pectus carinatum, the protruding chest coded separately as Q67.7, needs compression rather than suction, so a vacuum bell is the wrong tool for it. And anyone with a cardiac condition, a bleeding or clotting disorder, a vasculopathy, a skeletal disorder of the chest wall, or active skin disease over the treatment area needs clinical clearance before starting. A diagnosis code, on its own, captures none of these distinctions, which is exactly why the code is a starting point and not a plan.

What this means in practice

A diagnostic code and a Haller measurement tell you what you have and roughly how marked it is. They do not tell you what to do, and three practical points follow from the evidence.

First, get a proper assessment before you buy anything. Symptoms, chest flexibility and severity are clinical judgements, and an echocardiogram and lung function test change the plan when the heart or lungs are involved.

Second, in a young child, age is the one variable you cannot recover. Cartilage stiffens steadily as a child grows, so every month of delay narrows the window in which the chest responds most readily. If the chest is flexible, the case for raising a supervised trial early with a paediatrician is stronger than the case for waiting.

Third, the two active treatment routes carry very different downsides. A vacuum bell can be stopped at any time. Surgical repair, the Nuss procedure described by Nuss and colleagues in 1998, leaves a bar in the chest for roughly two to three years and needs a second operation to remove it. Neither the code nor the scan makes that choice for you.

Not sure whether this applies to you?

The question this article cannot answer for you is whether your own chest is a reasonable candidate for conservative treatment. The FormaChest assessment takes about four minutes. It screens your situation against the variables the research identifies as predictive (age, depth of the indentation, chest flexibility and symptoms) and returns an honest read on whether conservative treatment is a reasonable first step, including telling you when the answer is to see a surgeon first.

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What the research does not tell us

Presenting the coding and the evidence as more settled than they are would be misleading. The ICD-10 code Q67.6 is a diagnostic label only. It carries no information about severity, symptoms or the right treatment, so it cannot be used to predict how any individual chest will behave. The epidemiology is approximate. Incidence figures range across series from 1 in 300 to 1 in 1,000, and the reported male-to-female ratio spans a wide band, because the condition is counted differently in different places. The measurement science has known limits too. The Haller index overlaps between affected and unaffected people, which is why the correction index exists, and no single cut-off perfectly separates a chest that needs surgery from one that does not. On treatment, there are no randomised controlled trials of vacuum bell therapy against surgery, a sham device, or no treatment, and Haecker and colleagues (2024) note that no validated international guidelines for the therapy exist after twenty years of use. Long-term durability data is weak: whether a correction achieved in childhood holds through later growth and adult life is not well established.

About this guide

Published by FormaChest (AUGUMENTUM SRL, Romania). We manufacture non-surgical vacuum bell correction systems and sell nothing related to the procedure described above. This article exists because the decision described here should be made on the evidence, including the evidence that points toward surgery.

Tomas Titus is the founder of FormaChest (AUGUMENTUM SRL, Craiova, Romania). He had pectus excavatum and corrected it without surgery, documenting his own vacuum bell treatment on camera, taking measurements before each session rather than after. His chest depth went from 25mm to 4mm. That is one person's result at 19; published adult timelines run 12 to 24 months and results vary. He is not a clinician, and nothing in this article replaces assessment by one.

Related questions

• What is pectus excavatum?
• What is the Haller index?
• What are the symptoms beyond the physical?
• How much does the Nuss procedure cost?

References

1. Zhou Y, et al. Questionnaire-based subjective evaluation of vacuum bell treatment in children with pectus excavatum. Frontiers in Pediatrics. 2024. PMID 39439449
2. Haecker FM. Vacuum bell therapy. Annals of Cardiothoracic Surgery. 2016. PMID 27747177
3. Haecker FM, et al. 20 years clinical application of the vacuum bell for conservative treatment of pectus excavatum. Journal of Thoracic Disease. 2024. PMID 39268139
4. St. Peter SD, et al. The Correction Index: Setting the Standard for Recommending Operative Repair of Pectus Excavatum. Annals of Thoracic Surgery. 2014.
5. Nuss D, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. 1998.