An asymptomatic 52-year-old man was found to have an abnormal chest roentgenogram on a routine evaluation.
Congenital absence of the left pectoral muscle.Figure 1 shows unilateral hyperlucency of the left lung field. The clue to the diagnosis was the discrepancy in extrathoracic soft-tissue shadows. Physical examination disclosed that the patient had congenital absence of the left pectoralis major, left nipple, and left chest wall hair (Fig 2). The unilateral deficiency in muscle mass had caused the diminished density on the chest film.This anomaly is a form of Poland's1 syndrome, an embryologic defect of the mesoderm first recognized in 1841 and recently reviewed.2,3 Patients with Poland's syndrome have a variable incidence of syndactyly, brachydactylia, hypoplasia of some of the elements of the corresponding upper extremity, thoracic cage defect, absent nipple, and axillary web.When presented with a roentgenogram of a unilateral hyperlucent lung, one must