Poland's syndrome mimicking traumatic chest injury

Abstract

Poland's syndrome (PS) is a rare developmental anomaly that can manifest mild (pectoralis muscles involvement) to severe deformities (rib hypoplasia and hand deformities). We report a case of 69-year-old man who presented to the emergency department with a traumatic chest injury after a fall. It was initially thought to have a significant chest injury as the trauma survey revealed a palpable defect and tenderness in the right anterior chest wall. There was also a symbrachydactyly deformity in the right hand. CT of the chest showed lack of right pectoralis muscles, which were consistent with PS. This case highlights the importance of gathering detail history in adult trauma patients such as congenital disorder especially in the presence of bony deformity. With possibilities of several traumatic conditions in trauma patients eliminated, one can expand the non-traumatic differential, keeping in mind the possibility of a congenital disorder that can mimic traumatic chest injury.

Keywords: congenital disorders; genetic screening / counselling; trauma.

Figure 1

Symbrachydactyly (brachydactyly, syndactyly and global hypoplasia) of the right hand was noted.

Figure 2

Chest radiograph did not show any abnormalities such as fractured rib or haemopneumothorax.

Figure 3

Axial contrast-enhanced CT of the patient’s chest showed the absence of right pectoralis major and minor muscles (white stars), which were consistent with Poland’s syndrome.