Lung herniation: an uncommon presentation of Poland's syndrome in a neonate at birth

Abstract

A term male infant was admitted to the neonatal intensive care unit with an asymmetric chest wall and a herniating mass through the left fourth intercostal space. While crying, the left fourth intercostal space revealed a mass which herniated on expiration and receded on inspiration. On auscultation, the heart sounds were audible on the right side of the chest. Systemic examination was otherwise unremarkable. A roentgenogram of the chest revealed dextrocardia and hyperlucent left lung fields. Echocardiogram showed dextrocardia with a structurally normal heart. A clinical diagnosis of Poland's syndrome was made based on the hypoplasia of the left pectoral muscles, ribs and nipple, dextrocardia and lung herniation. He was thriving well when reviewed at 2 years of age.

Figure 1

Infant with Poland's syndrome showing the lung herniation on expiration.

Figure 2

Infant showing hypoplasia of the left pectoral muscles and areola. On expiration intercostal recession is noted.

Figure 3

X-ray of the chest with hyperlucent left lung fields and dextrocardia.