Unilateral Deformity of the Chest
Am Fam Physician. 1998 Feb 1;57(3):521-522.
A 10-week-old male infant was brought in by his mother for an examination after she noticed an abnormality in his upper thorax. Pregnancy and delivery were unremarkable. On physical examination, he was found to have partial absence of the pectoralis major muscle of the right shoulder girdle (Figures 1 and 2). In other respects, the examination was unremarkable.
What is the name of this well-described congenital syndrome?
A. Poland's anomaly.
B. Sprengel's deformity.
C. Haglund's deformity.
D. Weber's syndrome.
E. Trousseau's syndrome.
The answer is A: Poland's anomaly. Poland's anomaly (also called Poland's syndrome) was first described by Alfred Poland in 1841.1 It is a congenital anomaly with variable penetration, consisting of a unilateral absence of components of the shoulder girdle and upper extremities, particularly the pectoralis major and minor muscles.2,3 Poland's anomaly is often associated with syndactyly of the ipsilateral hand.
In this child, decreased muscle bulk of the pectoralis major muscle on the right side can be seen. This is the area of dimpling superior and lateral to the right nipple (bottom figure). In a female child, this would create a significant cosmetic deformity after puberty. Augmenting the breast area in a female with Poland's anomaly often provides an interesting challenge to plastic and reconstructive surgeons. The abnormality in the child presented here is being followed by observation only, and it may not have a significant impact on him, although he may experience some loss of strength. The use of physical therapy may help to develop compensatory muscles to preserve as much shoulder girdle function as possible.
1. Poland A. Deficiency of the pectoral muscles. Guy Hosp Rep. 1841;6:191–3.
2. Jones KL. Smith’s Recognizable patterns of human malformation. 4th ed. Philadelphia: Saunders, 1988:260–1.
3. Van Heest AE. Congenital disorders of the hand and upper extremity. Pediatr Clin North Am. 1996;43:1113–33.
Contributing editor is Marc S. Berger, M.D., C.M., The Reading Hospital and Medical Center, Reading, Pennsylvania.
The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at http://www.aafp.org/afp/photoquizinfo. To be considered for publication, submissions must meet these guidelines. E-mail submissions to email@example.com.
Copyright © 1998 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact firstname.lastname@example.org for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions
More in AFP
MOST RECENT ISSUE
Feb 15, 2019
Access the latest issue of American Family Physician