Mild vs severe pectus excavatum: where the line is and when to see a doctor

By Javier Santana, founder of Pectus Academy · Updated October 2026

Short answer: there is no single line. Doctors combine the CT measurement (Haller index: up to 2.5 normal, above 3.2 severe), symptoms, and heart and lung tests. A pectus can look deep and cause no physical symptoms, and still weigh heavily on how you see yourself. That is why appearance alone is not enough to decide.

How is severity measured?

• Haller index: the width of the chest divided by the distance from the breastbone to the spine, on a CT scan. The explanation and a calculator are in Haller index.
• Correction index: what percentage of the chest depth the dip takes up. It was proposed because the Haller index overlaps a lot between people with and without pectus.
• Symptoms and function tests: what really decides.

A rough guide: mild or severe

This is a rough guide. The classification is made by a doctor with the tests in front of them.

When to see a doctor

• If you notice shortness of breath, chest pain, palpitations or fainting.
• If you tire more than usual during exercise.
• If the dip is getting deeper.
• If it is a child or teenager who is still growing: that is when it changes most and when there are the most options.
• If it affects your daily life so much that it shapes what you do.

You can start with your family doctor or pediatrician, who will refer you to thoracic or pediatric surgery if needed.

Which tests are done?

• A physical exam, which is sometimes enough for the diagnosis.
• A chest X-ray or CT scan.
• An electrocardiogram and an echocardiogram.
• Lung function tests.
• Exercise testing.

Does it get worse over time?

It can. It usually becomes more visible with the growth spurt of puberty, and the dip can keep getting deeper into adulthood.

What if it is mild?

A mild pectus with no symptoms does not need surgery. The usual approach is to work on posture and muscle, and mild, symmetric cases are also the ones that respond best to the vacuum bell. Being mild on the tests does not mean it does not affect you: the impact on body image is documented in studies and counts when deciding.

Keep reading

• Can you fix pectus excavatum without surgery?
• Surgery vs conservative treatment
• Vacuum bell: how it works and what the evidence says

To start with the lowest-risk step, get the free guide to the 4 posture mistakes.

This content is educational and does not replace the advice of a healthcare professional. We do not promise a specific result.

Sources

1. Sharma G, Carter YM. Pectus Excavatum. StatPearls, updated February 15, 2026. ncbi.nlm.nih.gov/books/NBK430918
2. Mayo Clinic. Pectus excavatum: symptoms, causes, diagnosis and treatment. mayoclinic.org
3. St Peter SD, Juang D, Garey CL, et al. A novel measure for pectus excavatum: the correction index. Journal of Pediatric Surgery, 2011;46(12):2270-2273.
4. Haecker FM, Sesia S. Vacuum bell therapy. Annals of Cardiothoracic Surgery, 2016. annalscts.com
5. Steinmann C, et al. Pectus excavatum and pectus carinatum patients suffer from lower quality of life and impaired body image. European Journal of Cardio-Thoracic Surgery, 2011;40(5):1138-1145.