Presentation
Asymmetric right anterior chest swelling.
Patient Data
Tilted sternum with its right margin being more anteriorly positioned to its left margin. Mild asymmetric anterior convexity of the right 4th and 5th costal cartilage, which correspond to the clinically palpable swelling.
Case Discussion
Palpable chest lumps are common in children, and they are likely caused by benign variations in the anatomy of the anterior chest wall.
Variations of the anterior chest wall including variations of the sternum such as pectus excavatum, pectus carinatum, and tilted sternum as in this case, variations of the ribs and costal cartilage including prominent convexity of anterior rib or costal cartilage, prominent asymmetric costal cartilage, parachondral nodules 1.
Multislice CT scans with reformatting and 3D reconstructions are useful to identify those variations. Surface-rendered 3D images of the patient's skin surface as in this case are helpful to identify the protrusion palpated on physical examination.
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