J Korean Soc Radiol.  2014 Oct;71(4):178-181. 10.3348/jksr.2014.71.4.178.

Incidental Finding of Unilateral Isolated Aplasia of Serratus Anterior Muscle and Winged Scapula on Chest Radiograph: A Case Report

• Choi J
• Park HJ
• Ko JM

• KMID: 2098002
• DOI: http://doi.org/10.3348/jksr.2014.71.4.178

Abstract

The isolated aplasia of the serratus anterior muscle with winging of scapula is very rare, and only a few cases are reported. Here, we present a case of a 30-year-old Korean male who initially presented with a left flank pain. His physical exam did not show any significant finding in his right shoulder. However, his chest radiograph showed absence of right serratus anterior muscle and slightly elevated and medially rotated right scapula. Subsequent CT scan showed the right serratus anterior muscle aplasia and medial winging of the right scapula. This case is unique in two aspects. First, the combination of abnormalities is different from the typical congenital abnormalities involving shoulder girdle, such as Sprengel deformity or Poland syndrome. Secondly, this was incidentally diagnosed with chest radiograph, without clinical impression. Careful reading of chest radiograph can help the radiologists to detect such clinically silent abnormalities.

MeSH Terms

Adult
Congenital Abnormalities
Flank Pain
Humans
Incidental Findings*
Male
Poland Syndrome
Radiography, Thoracic*
Scapula*
Shoulder
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Chest radiograph (A) shows absence of right serratus muscle shadow compared to the other side showing normal chest wall with the shadows of serratus anterior, intermuscular fat plane, latissimus dorsi, and subcutaneous fat from medial to lateral. The right scapula is elevated by 0.9 cm compared to the opposite side, and the inferior pole of the right scapula is medially rotated. Axial chest CT scan shows increased distance between the medial border of right scapula and right rib cage, compatible with medial winging of right scapula (B). Axial (C) and coronal (D) chest CT scans show the absence of right serratus anterior muscle.

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