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RARE OR OBSCURE CASES
A
CASE
OF
CONGENITAL DEFECT OF THE
SPRENGEL’S DEFORMITY.
THORAX,
325
WITH
BY CAPTAIN HAROLD BURROWS, R.A.M.C. (T.P.)
THEpatient, age 20, is a private in the machine-gun corps. I n peace time he is a grocer’s
assistant.
All his life he has noticed a bulging of the left chest whenever he coughed,
1 : ~ .?9C,.--L’atierit nlicii a t ease. Outliiies 011
rlicst dernarrate boiiiiilaries of defect i n chesc wall as
eii<.ited by lmlpatioii aiid verified by rsdiogam.
PIG. ?!?i.--Shows
patient while mn1:itic.
expiratory etfort.
:I
forreii
but he has not experienced any particular inconvenience from this. He was able to
undergo his course of training as a soldier, and
made no complaint on account of his deformity,
though he says he has always found it difficult t o
carry his pack.
On examination of his chest, i t was found
that the left anterior chest wall is defective, considerable sections of the second, third, and fourth
costal cartilages and ribs being ahsent (BYgs. 296,
297). The remaining ribs are normal in number,
position, and shape. The pectoralis major on the
affected side is ill-developed ; otherwise no defect
of muscle or nerve is t o be observed. The left
nipple is smaller than the right, and is situated at
a higher level. A hernia of the lung is visible
when the patient coughs.
On viewing the patient from behind, the left
shoulder is seen t o be hunched up, while the left
scapula is slightly smaller than the right, nearer
t o the vertebrre, and at a higher level (Pig.298).
The scapular muscles, however, appear t o be well
developed, though the posterior superior angle of
FIG. 2!18.-Back view of patient.
the scapula is more clearly noticeable on the left
side than on the right. There is a. lateral curvature of the spine. with the masimrirn
ciirve in the dorsal region, the convexity being directed to the right.
326
THE BRITISH JOURNAL O F SURGERY
The left chest is retracted t o a remarkable degree, as shown by the accompanying
cyrtometer tracings (Pigs. 299, 300, 301).
My colleague, Lieutenant S. Owen, informs me that there is no dextrocardia or
other visceral abnormality to be found, nor are there any congenital defects other than
those already mentioned
FIG.P~g.-Cyrtometer tracing a t level of iirst interspace.
FIG.300.-Traciiig
R
at level of fourth rib cartilagc.
= 18 in.
L
=
14;
ill.
Circumferential measurement : R = 20 in.
FIG. 301.-Tracing
R
=
L = 1st in.
at level of tip of eighth cartilage.
151 in. L = 111 in.
The case is remarkable on account of its rarity, and also because the patient suffered
so little inconvenience from his abnormalities.
I am indebted to Dr. F. Brigham, of Harvard University, for the photographs.
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