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Logo of bmjcrInstructions for authorsCurrent ToCBMJ Case Reports
BMJ Case Rep. 2010; 2010: bcr11.2009.2437.
Published online Mar 26, 2010. doi:  10.1136/bcr.11.2009.2437
PMCID: PMC3028266
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An unusual case of unequal chest expansion
James David Griffin1 and Nigel Hollister2
1Plymouth Hospitals NHS Trust, Anaesthesia, Derriford Hospital, Derriford Road, Plymouth PL6, UK
2Musgrove Park Hospital, Anaesthesia, Taunton, Somerset TA1 5DA, UK
Correspondence to James David Griffin, jgrifter/at/
A 62-year-old man was admitted to hospital following successful resuscitation from an out-of-hospital cardiac arrest. He was witnessed to fall off his bicycle and received 4 min of bystander basic life support followed by 12 min of advanced life support before return of spontaneous circulation.
On arrival in the emergency department, an initial examination revealed inequality in chest expansion, with reduced movement on the right, but increased breath sounds. The endotracheal tube was appropriately placed and an initial diagnosis of a right flail segment was made. A computed tomography (CT) scan of the chest revealed an absence of pectoralis major muscle on the right and on inspection brachydactyly of the ipsilateral hand (figs 1 and and2).2). An incidental diagnosis of Poland syndrome was made. This condition is rare, affecting males three times as often as females and the right side of the body twice as often as the left. The incidence is estimated to range from one in 7000 to one in 100 000 live births.1 Interruption of the subclavian arteries at about the 46th day of embryogenesis is the prevailing theory.2
Figure 1
Figure 1
Computed tomography scan of the thorax showing absence of pectoralis muscles on the right.
Figure 2
Figure 2
Brachydactyly of the ipsilateral hand.
Competing interests: None.
Patient consent: Patient/guardian consent was obtained for publication.
1. Fokin AA, Robicsek F. Poland’s syndrome revisited. Ann Thorac Surg 2002; 74: 2218–25. [PubMed]
2. Poullin P, Toussirot E, Schiano A, et al. [Complete and dissociated forms of Poland’s syndrome (5 cases)]. Rev Rhum Mal Osteoartic 1992; 59: 114–20. [PubMed]
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