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
Carragee EH et al: Poland's syndrome: When there is no breast. Breast J. 23(6):726-730, 2017
Lee YK et al: US and MR imaging of pectoralis major injuries. Radiographics. 37(1):176-189, 2017
Cusano AG & Wong MS: Poland's Syndrome. In: Surgery for Chest Wall Deformities. Switzerland: Springer International. 47-69, 2017
Brochhausen C et al: Pectus excavatum: history, hypotheses and treatment options. Interact Cardiovasc Thorac Surg. 14(6):801-6, 2012
Huber KM et al: Implications of anomalous pectoralis muscle in reconstructive breast surgery: the oblique pectoralis anterior. Eplasty. 12:e44, 2012
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
Blanco FC et al: Management of congenital chest wall deformities. Semin Plast Surg. 25(1):107-16, 2011
Paraskevas GK et al: Bilateral pectoral musculature malformations with concomitant vascular anomaly. Folia Morphol (Warsz). 69(3):187-91, 2010
Restrepo CS et al: Imaging appearances of the sternum and sternoclavicular joints. Radiographics. 29(3):839-59, 2009
Soni S et al: Anomalous pectoral musculature. Anat Sci Int. 83(4):310-3, 2008
Creswick HA et al: Family study of the inheritance of pectus excavatum. J Pediatr Surg. 41(10):1699-703, 2006
Kazama T et al: Prospective evaluation of pectoralis muscle invasion of breast cancer by MR imaging. Breast Cancer. 12(4):312-6, 2005
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
Fokin AA et al: Poland's syndrome revisited. Ann Thorac Surg. 74(6):2218-25, 2002
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
Connell DA et al: Injuries of the pectoralis major muscle: evaluation with MR imaging. Radiology. 210(3):785-91, 1999
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
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References
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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
Carragee EH et al: Poland's syndrome: When there is no breast. Breast J. 23(6):726-730, 2017
Lee YK et al: US and MR imaging of pectoralis major injuries. Radiographics. 37(1):176-189, 2017
Cusano AG & Wong MS: Poland's Syndrome. In: Surgery for Chest Wall Deformities. Switzerland: Springer International. 47-69, 2017
Brochhausen C et al: Pectus excavatum: history, hypotheses and treatment options. Interact Cardiovasc Thorac Surg. 14(6):801-6, 2012
Huber KM et al: Implications of anomalous pectoralis muscle in reconstructive breast surgery: the oblique pectoralis anterior. Eplasty. 12:e44, 2012
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
Blanco FC et al: Management of congenital chest wall deformities. Semin Plast Surg. 25(1):107-16, 2011
Paraskevas GK et al: Bilateral pectoral musculature malformations with concomitant vascular anomaly. Folia Morphol (Warsz). 69(3):187-91, 2010
Restrepo CS et al: Imaging appearances of the sternum and sternoclavicular joints. Radiographics. 29(3):839-59, 2009
Soni S et al: Anomalous pectoral musculature. Anat Sci Int. 83(4):310-3, 2008
Creswick HA et al: Family study of the inheritance of pectus excavatum. J Pediatr Surg. 41(10):1699-703, 2006
Kazama T et al: Prospective evaluation of pectoralis muscle invasion of breast cancer by MR imaging. Breast Cancer. 12(4):312-6, 2005
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
Fokin AA et al: Poland's syndrome revisited. Ann Thorac Surg. 74(6):2218-25, 2002
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
Connell DA et al: Injuries of the pectoralis major muscle: evaluation with MR imaging. Radiology. 210(3):785-91, 1999
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
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