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Pectoralis Muscle and Chest Wall Variants
Lauren Q. Chang Sen, MD; Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Pectoralis major muscle (PMM)
          • Definitions

            • Pectoralis muscle variants: Congenital or developmental variations in pectoralis muscle appearance
            • Poland syndrome: Unilateral absence of sternocostal head of PMM
              • Ipsilateral breast may be hypoplastic or absent
              • ± anomalies of ipsilateral upper limb, including brachydactyly, syndactyly, and ecterodactyly
              • Has evolved to include anomalies of musculoskeletal system of chest and upper limb of variable severity
            • Chest wall variants: Anomalies in chest wall growth, congenital or acquired
              • Haller index (pectus index)
                • Transverse diameter of chest divided by AP diameter
                • Normal 2.56 (SD 0.35)
              • Pectus excavatum (funnel chest)
                • Most common congenital chest wall deformity
                • Variable depression of sternum and lower costal cartilages; pectus index ≥ 3.25
              • Pectus carinatum
                • 2nd most common congenital chest wall deformity
                • Body of sternum and adjacent costal cartilages protrude, similar to pigeon breast
                • Pectus index 1.42-1.98
                • Symmetrical chondrogladiolar deformity: Symmetrical protrusion of sternal body and lower costal cartilages; most common
                • Asymmetrical chondrogladiolar deformity: Normal cartilage on one side and protrusion on other
                • Mixed carinatum and excavatum deformities
                • Chondromanubrial deformity: Anterior protrusion of upper chest, including manubrium, 2nd and 3rd costal cartilages

          IMAGING

          • General Features

            • Mammographic Findings

              • Ultrasonographic Findings

                • MR Findings

                  • CT Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        • Reporting Tips

                                          Selected References

                                          1. Carragee EH et al: Poland's syndrome: When there is no breast. Breast J. 23(6):726-730, 2017
                                          2. Lee YK et al: US and MR imaging of pectoralis major injuries. Radiographics. 37(1):176-189, 2017
                                          3. Cusano AG & Wong MS: Poland's Syndrome. In: Surgery for Chest Wall Deformities. Switzerland: Springer International. 47-69, 2017
                                          4. Brochhausen C et al: Pectus excavatum: history, hypotheses and treatment options. Interact Cardiovasc Thorac Surg. 14(6):801-6, 2012
                                          5. Huber KM et al: Implications of anomalous pectoralis muscle in reconstructive breast surgery: the oblique pectoralis anterior. Eplasty. 12:e44, 2012
                                          6. Stylianos K et al: Muscle abnormalities of the chest in Poland's syndrome: variations and proposal for a classification. Surg Radiol Anat. 34(1):57-63, 2012
                                          7. Blanco FC et al: Management of congenital chest wall deformities. Semin Plast Surg. 25(1):107-16, 2011
                                          8. Paraskevas GK et al: Bilateral pectoral musculature malformations with concomitant vascular anomaly. Folia Morphol (Warsz). 69(3):187-91, 2010
                                          9. Restrepo CS et al: Imaging appearances of the sternum and sternoclavicular joints. Radiographics. 29(3):839-59, 2009
                                          10. Soni S et al: Anomalous pectoral musculature. Anat Sci Int. 83(4):310-3, 2008
                                          11. Creswick HA et al: Family study of the inheritance of pectus excavatum. J Pediatr Surg. 41(10):1699-703, 2006
                                          12. Kazama T et al: Prospective evaluation of pectoralis muscle invasion of breast cancer by MR imaging. Breast Cancer. 12(4):312-6, 2005
                                          13. Salhab M et al: Pneumothorax after a clinical breast fine-needle aspiration of a lump in a patient with Poland's syndrome. Int Semin Surg Oncol. 2:14, 2005
                                          14. Fokin AA et al: Poland's syndrome revisited. Ann Thorac Surg. 74(6):2218-25, 2002
                                          15. Morris EA et al: Evaluation of pectoralis major muscle in patients with posterior breast tumors on breast MR images: early experience. Radiology. 214(1):67-72, 2000
                                          16. Connell DA et al: Injuries of the pectoralis major muscle: evaluation with MR imaging. Radiology. 210(3):785-91, 1999
                                          17. Bavinck JN et al: Subclavian artery supply disruption sequence: hypothesis of a vascular etiology for Poland, Klippel-Feil, and Möbius anomalies. Am J Med Genet. 23(4):903-18, 1986
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • Pectoralis major muscle (PMM)
                                                  • Definitions

                                                    • Pectoralis muscle variants: Congenital or developmental variations in pectoralis muscle appearance
                                                    • Poland syndrome: Unilateral absence of sternocostal head of PMM
                                                      • Ipsilateral breast may be hypoplastic or absent
                                                      • ± anomalies of ipsilateral upper limb, including brachydactyly, syndactyly, and ecterodactyly
                                                      • Has evolved to include anomalies of musculoskeletal system of chest and upper limb of variable severity
                                                    • Chest wall variants: Anomalies in chest wall growth, congenital or acquired
                                                      • Haller index (pectus index)
                                                        • Transverse diameter of chest divided by AP diameter
                                                        • Normal 2.56 (SD 0.35)
                                                      • Pectus excavatum (funnel chest)
                                                        • Most common congenital chest wall deformity
                                                        • Variable depression of sternum and lower costal cartilages; pectus index ≥ 3.25
                                                      • Pectus carinatum
                                                        • 2nd most common congenital chest wall deformity
                                                        • Body of sternum and adjacent costal cartilages protrude, similar to pigeon breast
                                                        • Pectus index 1.42-1.98
                                                        • Symmetrical chondrogladiolar deformity: Symmetrical protrusion of sternal body and lower costal cartilages; most common
                                                        • Asymmetrical chondrogladiolar deformity: Normal cartilage on one side and protrusion on other
                                                        • Mixed carinatum and excavatum deformities
                                                        • Chondromanubrial deformity: Anterior protrusion of upper chest, including manubrium, 2nd and 3rd costal cartilages

                                                  IMAGING

                                                  • General Features

                                                    • Mammographic Findings

                                                      • Ultrasonographic Findings

                                                        • MR Findings

                                                          • CT Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Consider

                                                                              • Image Interpretation Pearls

                                                                                • Reporting Tips

                                                                                  Selected References

                                                                                  1. Carragee EH et al: Poland's syndrome: When there is no breast. Breast J. 23(6):726-730, 2017
                                                                                  2. Lee YK et al: US and MR imaging of pectoralis major injuries. Radiographics. 37(1):176-189, 2017
                                                                                  3. Cusano AG & Wong MS: Poland's Syndrome. In: Surgery for Chest Wall Deformities. Switzerland: Springer International. 47-69, 2017
                                                                                  4. Brochhausen C et al: Pectus excavatum: history, hypotheses and treatment options. Interact Cardiovasc Thorac Surg. 14(6):801-6, 2012
                                                                                  5. Huber KM et al: Implications of anomalous pectoralis muscle in reconstructive breast surgery: the oblique pectoralis anterior. Eplasty. 12:e44, 2012
                                                                                  6. Stylianos K et al: Muscle abnormalities of the chest in Poland's syndrome: variations and proposal for a classification. Surg Radiol Anat. 34(1):57-63, 2012
                                                                                  7. Blanco FC et al: Management of congenital chest wall deformities. Semin Plast Surg. 25(1):107-16, 2011
                                                                                  8. Paraskevas GK et al: Bilateral pectoral musculature malformations with concomitant vascular anomaly. Folia Morphol (Warsz). 69(3):187-91, 2010
                                                                                  9. Restrepo CS et al: Imaging appearances of the sternum and sternoclavicular joints. Radiographics. 29(3):839-59, 2009
                                                                                  10. Soni S et al: Anomalous pectoral musculature. Anat Sci Int. 83(4):310-3, 2008
                                                                                  11. Creswick HA et al: Family study of the inheritance of pectus excavatum. J Pediatr Surg. 41(10):1699-703, 2006
                                                                                  12. Kazama T et al: Prospective evaluation of pectoralis muscle invasion of breast cancer by MR imaging. Breast Cancer. 12(4):312-6, 2005
                                                                                  13. Salhab M et al: Pneumothorax after a clinical breast fine-needle aspiration of a lump in a patient with Poland's syndrome. Int Semin Surg Oncol. 2:14, 2005
                                                                                  14. Fokin AA et al: Poland's syndrome revisited. Ann Thorac Surg. 74(6):2218-25, 2002
                                                                                  15. Morris EA et al: Evaluation of pectoralis major muscle in patients with posterior breast tumors on breast MR images: early experience. Radiology. 214(1):67-72, 2000
                                                                                  16. Connell DA et al: Injuries of the pectoralis major muscle: evaluation with MR imaging. Radiology. 210(3):785-91, 1999
                                                                                  17. Bavinck JN et al: Subclavian artery supply disruption sequence: hypothesis of a vascular etiology for Poland, Klippel-Feil, and Möbius anomalies. Am J Med Genet. 23(4):903-18, 1986