assymetric chest wall

[RUOkie]

Just saw an interesting young man (kid) in my office. Was seen by his family doc last week for a pre-participation/well child physical, and PCP called me and asked me to see him.

13 y/o boy currently in puberty has noticed that his R chest is not developed as much as his L. No pain, no functional loss, but he has noticed it more over the past year. He has had some abnormality for as long as he can remember.

He is a very talented soccer player, and now is self concious about it.

First: What is likely wrong?
Second: What to do about it?
third: How could we prove it? What other questions do you have for me or the family?

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[pmr4life]

First....more history: What exactly do you mean by "right chest is not as developed as his left?" As in....does the actual thorax on the right appear smaller? Or, is there an illusion of a smaller right chest secondary to thoracic scoliosis? Or....my money is on...he has congenitally absent musculature, (Pec major) and puberty is slinging his muscle bulk into high gear, thus making the right side appear smaller? Prove it with MSK U/S...could stick a needle in it (depending on the muscle). More history, please.

 

[RUOkie]

First....more history: What exactly do you mean by "right chest is not as developed as his left?" As in....does the actual thorax on the right appear smaller? Or, is there an illusion of a smaller right chest secondary to thoracic scoliosis? Or....my money is on...he has congenitally absent musculature, (Pec major) and puberty is slinging his muscle bulk into high gear, thus making the right side appear smaller? Prove it with MSK U/S...could stick a needle in it (depending on the muscle). More history, please.

Winner Winner Chicken Dinner.

No scoliosis, strength is normal, but like you suggested, there does not appear to be a R pec Major. Pec minor is very well defined.

I offered to either EMG or US to prove it. But I explained that this was merely cosmetic and there was nothing to do about it unless he was having discomfort. (I did not go into the possibility of plastic surgery for a pec implant, despite that being possible). I did suggest that he avoid straight bench press so that his L side does not become over developed.

He and mom deferred the EMG.

This is the most common congenital muscle absence, despite it being fairly rare. First described in JAMA in 1915.

 

[SSdoc33]

Winner Winner Chicken Dinner.

No scoliosis, strength is normal, but like you suggested, there does not appear to be a R pec Major. Pec minor is very well defined.

I offered to either EMG or US to prove it. But I explained that this was merely cosmetic and there was nothing to do about it unless he was having discomfort. (I did not go into the possibility of plastic surgery for a pec implant, despite that being possible). I did suggest that he avoid straight bench press so that his L side does not become over developed.

He and mom deferred the EMG.

This is the most common congenital muscle absence, despite it being fairly rare. First described in JAMA in 1915.

interesting case.

id guess that there will be a functional / strength difference in the 2 sides, thus it is not "just" cosmetic. as he gets older, he will notice that his right side will be weaker in many athletic activities.

certainly no platsic surgery now, but once he is fully grown, i think that is a reasonable option.