A case of Poland Syndrome associated with dextroposition

Unilateral Absence of the Latissimus Dorsi: A Report of a Rare Case

The latissimus dorsi is the largest muscle in the human body, located in the lower posterior thorax, and it contributes to motion in the upper extremity and provides assistance in respiration. This case report describes a rare occurrence of a unilateral absence of the latissimus dorsi accompanied by contralateral scoliosis in a 73-year-old female cadaver. The absence of the muscle along with the absence of the thoracodorsal nerve and branches of the subscapular and axillary arteries was identified during a standard dissection course. The implications of this rare case extend to an array of surgical interventions, including head, neck, breast, and torso reconstructive applications. It is important to investigate potential anomalies of the latissimus dorsi, while planning or performing free flap transfers. The report also highlights the importance of understanding this variation for educational and research purposes.

Poland's syndrome mimicking traumatic chest injury

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.

An Atypical Case of Poland Syndrome with Bilateral Features and Dextroposition of the Heart: In the work-up of Poland syndrome, different imaging modalities are necessary to depict the full extent of the anomalies

Poland syndrome is defined by the unilateral aplasia or hypoplasia of the sternocostal head of the major pectoral muscle and is associated with variable ipsilateral thoracic and upper limb anomalies. Most frequently, the abnormalities are unilateral and on the right side. We present an atypical case of Poland syndrome in a baby girl with bilateral chest abnormalities, mainly on the left side, and secondary dextroposition of the heart. As required in almost all cases of Poland syndrome, different imaging modalities were used to evaluate the extent of our patient’s anomalies.

Controversies in Poland Syndrome: Alternative Diagnoses in Patients With Congenital Pectoral Muscle Deficiency

PURPOSE

Poland syndrome was first described as a deficiency of the pectoral muscle with ipsilateral symbrachydactyly. Currently, numerous case reports describe variations of Poland syndrome in which pectoral muscle deficiency is often used as the only defining criterion. However, more syndromes can present with pectoral muscle deficiency. The aim of this review is to illustrate the diversity of the phenotypic spectrum of Poland syndrome and to create more awareness for alternative diagnoses in pectoral muscle deficiency.

METHODS

A systematic literature search was performed. Articles containing phenotypical descriptions of Poland syndrome were included. Data extraction included number of patients, sex, familial occurrence, and the definition of Poland syndrome used. In addition, hand deformities, thoracic deformities, and other deformities in each patient were recorded. Alternative syndrome diagnoses were identified in patients with a combination of hand, thorax, and other deformities.

RESULTS

One hundred-and-thirty-six articles were included, describing 627 patients. Ten different definitions of Poland syndrome were utilized. In 58% of the cases, an upper extremity deformity was found and 43% of the cases had an associated deformity. Classic Poland syndrome was seen in 29%. Fifty-seven percent of the patients with a pectoral malformation, a hand malformation, and another deformity had at least 1feature that matched an alternative syndrome.

CONCLUSIONS

Pectoral muscle hypoplasia is not distinctive for Poland syndrome alone but is also present in syndromes with other associated anomalies with a recognized genetic cause. Therefore, in patients with an atypical phenotype, we recommend considering other diagnoses and/or syndromes before diagnosing a patient with Poland syndrome. This can prevent diagnostic and prognostic errors.

CLINICAL RELEVANCE

Differentiating Poland syndrome from the alternative diagnoses has serious consequences for the patient and their family in terms of inheritance and possible related anomalies.

Poland syndrome

Poland's syndrome is a rare congenital condition, characterized by the absence of the sternal or breastbone portion of the pectoralis major muscle, which may be associated with the absence of nearby musculoskeletal structures. We hereby report an 8-year-old boy with typical features of Poland syndrome, the first documented case from Uttar Pradesh, India.

Neurofibroma and Pectoralis Muscle Hypoplasia: A Mild Degree of Poland's Syndrome

BACKGROUND

Poland's Syndrome (PS) is a rare congenital syndrome characterized by the unilateral partial or complete absence of the sternocostal head of the pectoralis major muscle and ipsilateral brachysyndactyly or syndactyly of the fingers. It has been reported to be associated with other diseases, but PS accompanied by neurofibroma has rarely been reported.

CASE REPORT

We report a rare case of a 16-year-old man with neurofibroma of the left breast accompanied by PS. Physical examination showed a mass in the left breast with skin hyperpigmentation and increased body hair. Intraoperative exploration showed a mass measuring 3-4 cm between the dysplastic pectoralis major and minor muscles. Pathologic examination of the resected mass showed cutaneous diffuse neurofibroma. A simple left mastectomy was performed. The postoperative course was uneventful with no evidence of recurrence at 4 months.

CONCLUSION

Neurofibroma may also be accompanied by PS and should be differentiated from gynecomastia when a tumor grows in the breast.

Left-sided Poland's syndrome in a girl with rare associations like spina bifida and diaphragmatic hernia

Poland's syndrome is a rare congenital anomaly characterised by partial or complete absence of sternocostal head of pectoralis major muscle and anomalies of ipsilateral hand and digits. Other associated anomalies involving anterior thoracic wall, breast, diaphragm and vertebrae have also been reported in various cases. We report a case of a 10-year-old girl, with features of left-sided Poland's syndrome associated with spina bifida, dextroposition of the heart and left-sided diaphragmatic hernia. These are rare associations of Poland's syndrome. She was investigated with chest X-ray, contrast-enhanced CT of the thorax, ultrasonography of abdomen and echocardiography which helped in arriving at an accurate diagnosis and assessing all the associated abnormalities.

Complete unilateral right-sided absence of the pectoralis major and serratus anterior muscles in an adult male cadaver of South Indian origin

The unilateral complete absence of the pectoralis major and serratus anterior muscles in the absence of other anomalies is very rare. The complete absence of the pectoralis major and serratus anterior on the right side was observed during routine dissection of an elderly male cadaver of South Indian origin. Nodularity of the right fifth rib near the fifth costochondral junction was seen. The lateral pectoral and long thoracic nerves were present on the right side. Moderate right-sided disuse atrophy was noted in the pectoralis minor and the rotator cuff muscles due to a shoulder arthrodesis performed on that side. No abnormalities were noted on the left side. There was no family history of any upper limb anomalies suggestive of Poland's syndrome. The findings in the present case could be either due to a sporadic variant of Poland's syndrome or an isolated congenital unilateral absence of the pectoralis major and serratus anterior.

Poland syndrome: from embryological basis to plastic surgery

Poland syndrome is a rare congenital anomaly described by Sir Alfred Poland over 170 years ago. Combination of unilateral aplasia of the sternocostal head of musculus pectoralis major, and an ipsilateral hypoplastic hand with simple syndactyly and short fingers is typical for this condition. It occurs more frequent among males, and is usually situated on the right hemithorax in the unilateral form. The pathogenesis of Poland syndrome is not clear. Most of the authors assume that the etiologic insult is vascular in nature. During the sixth week of gestation, not only the pectoral mass splits (future muscles of the thorax) and intervening tissue between the finger rays of hands starts to disappear but also the vascular differentiation from six aortic arches begins. In our paper we report two cases of children with Poland syndrome, who underwent surgical procedure in the Department of Pediatric Surgery, Comenius University in Bratislava, Slovakia. Our case reports are focused on pre-operatively and also post-operatively imaging (RTG, CT, and 3D CT imaging) of the affected thorax and arm, as well as the operative reconstruction technique of abnormal ribs. We also discussed the possible embryonic backgrounds of this anomaly as well as the importance of plastic surgery resulting in patients' normal life.

A unique case of right-sided Poland syndrome with true dextrocardia and total situs inversus

Poland syndrome has been reported to be associated with true dextrocardia, but not with true situs inversus. In this report, we describe the first patient with total situs inversus in medical literature and try to highlight the syndrome's probable etiology and pathogenetic mechanisms in utero.