Title: A Murmur with Pectus Excavatum May Not Be Ominous

Authors: Dr C Sai Suveer Reddy, Dr T Ananth

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i1.121

Abstract

Background: Straight Back Syndrome (SBS) is the absence of normal dorsal curvature in the thoracic part of the spine, resulting in reduced AP diameter of the chest causing compression of the heart and great vessels.

Case Characteristics: 14-year-old Male child complains of chest pain. CVS-Pectus excavatum, S1,S2 normal; Pulmonary area-S2 wide, fixed/ejection systolic murmur, Grade-3/6.

Observation: Chest X-ray:Prominent main Pulmonary artery, loss of normal thoracic kyphosis, narrowing of AP diameter.

Outcome: The murmur provisionally thought to be from an ASD was diagnosed to be flow murmur of SBS.

Message: Murmurs in Pulmonary area associated with pectus excavatum should arise a suspicion of a murmur of SBS.

References

1.      Steven R. Boas, Nelson textbook of Pediatrics, first south asia edition,20 edition, Robert M. Kliegmann, Bonita F. Stanton, Joseph W. St Geme3 and Nina F. Schor, 2016;417.1:2144

2.    Grillo HC, Wright CD, Dartevelle PG, Wain JC, Murakami S. Tracheal compression caused by straight back syndrome, chest wall deformity, and anterior spinal displacement: techniques for relief. Ann Thoracic Surg. 2005;80:2057–62. [PubMed]

3.    Serrato M, Kezdi P. Absence of the physiologic dorsal kyphosis, cardiac signs and hemodynamic manifestations. Ann Internal Med. 1963;6:938–945. [PubMed]

4.      Ansari A. The “straight back” syndrome: current perspective more often associated with valvular heart disease than pseudoheart disease: a prospective clinical, electrocardiographic, roentgenographic, and echographic study of 50 patients. Clinical Cardiology. 1985;8:290–305. [Pub Med]

5. De Leon AC, Jr, Perloff JK, Twigg H, Majd M. The straight backsyndrome – clinical cardiovascular manifestations. Circulation.1965;32:193–203. [PubMed]

6.    Davies MK, Mackintosh P, Cayton RM, Page AJF, Shiu MF, Littler WA. The straight back syndrome. Q J Med. 1980;49:443–460. [PubMed]

Corresponding Author

Dr C Sai Suveer Reddy

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.