Acute Pericarditis in a Patient With Poland Syndrome

Poland syndrome is a rare congenital anomaly characterized by unilateral absence or hypoplasia of the pectoralis major muscle. We report the case of a 32-year-old man with previously undiagnosed Poland syndrome who presented with acute, severe, tearing chest pain radiating to the back, which worsened with sitting up and improved with lying down. The cardiac physical exam was negative for murmur and friction rub. Electrocardiograms showed focal ST-segment elevations in precordial leads V2-V4, and serial troponin levels were negative. Life-threatening cardiac causes of chest pain, such as acute coronary syndrome, aortic dissection, pulmonary embolism, and pneumothorax, were ruled out by a CT (computed tomography) scan. A transthoracic echocardiogram demonstrated a trivial anterior pericardial effusion with preserved ventricular function. Three out of four criteria for acute pericarditis were met. Treatment with colchicine 0.6 mg daily and indomethacin 25 mg three times daily resulted in complete resolution of symptoms within one week. To our knowledge, there are no reported cases of pericarditis in patients with Poland syndrome. However, hypothetically altered chest wall anatomy in Poland syndrome may predispose patients to pericardial irritation leading to pericarditis, which is idiopathic in nature.