Congenital Chest Wall Deformities

A 14-year-old boy is brought to the pediatric surgery clinic by his parents. They are concerned about a progressively deepening "dent" in the middle of his chest that they first noticed about 2 years ago. The patient himself is increasingly self-conscious, avoiding changing for gym class and swimming. He reports occasional sharp, non-radiating chest pain after running in soccer practice and feels he gets winded more easily than his teammates. He is otherwise healthy. On examination, you note a symmetrical, funnel-shaped depression of the lower sternum and adjacent costal cartilages. His heart sounds are regular but seem displaced to the left. The remainder of his physical exam is normal.