Poland syndrome is a rare congenital anomaly involving musculoskeletal malformations of the chest wall and ipsilateral upper limb [1–3]. It was first described by Sir Alfred Poland in 1841 [7]. It is of unknown etiology. Many theories have been proposed, but it seems that the interruption of embryonic blood supply to the subclavian artery, vertebral arteries and their branches, explains the occurrence of Poland syndrome and its variants [7, 8]. This condition usually occurs during the sixth week of gestation [7]. These vascular disturbances can also explain the appearance of other syndromes such as Möbius, Klippel-Feil and Adams-Oliver [7]. Other studies have implicated exposure to ergot alkaloids during the first trimester of pregnancy in the onset of the syndrome [7]. Since then, numerous variants and abnormalities associated with this syndrome have been described [9]. These include absence of the pectoralis minor or complete absence of both pectoral muscles, rib hypoplasia, hypoplasia of the scapula and its muscles, or even rare manifestations such as dextrocardia [3], renal agenesis, pneumothorax on the affected side [4], shoulder dislocation, abnormal hemostatic assessment and thrombocytopenia, growth hormone deficiency [7] or facial nerve paralysis [10]. In this observation, we report the case of a patient with the clinical criteria for Poland syndrome, confirmed by a CT scan, which is the examination of choice that can reveal all the anomalies described in this syndrome [5, 7]; it allows the assessment of muscular hypoplasia, in particular for the latissimus dorsi, but also the associated bone anomalies of the thoracic cage (pectus excavatum or associated carinatum) more precisely than chest X-ray. CT then provides additional assistance to clinicians to make the diagnosis more easily and to plastic surgeons to be aware of the exact abnormalities and proceed with surgical reconstruction. Mammography is routinely performed in adult women after 30 years of age, given that the association of Poland syndrome and breast neoplastic disease has been widely discussed [11]. In this reported case, we did not note any associated malformations of the upper limbs, which occur only in 12% of patients with Poland syndrome. But mild cases of Poland syndrome without upper limb involvement may not be evident until puberty, when the differences between the two sides become more apparent [1]. The disease causes alteration of the patient's body image, particularly in female patients, with the associated risk of mammary agenesis [7]. According to the literature, Poland syndrome has many clinical presentations. It could be difficult to diagnose for clinicians and plastic surgeons [7]. Treatment of these anomalies is based on surgical reconstruction, which should be performed from the age of 13-14 years in male patients with an intact latissimus dorsi [7]. The latter is usually harvested through a small dorsal and axillary incision and transposed to fill the void due to the absence of the pectoralis major muscle. Prosthesis reconstruction has been described for men, but the results are generally disappointing [12]. In women, as in men, abnormal development of the mammary gland can cause aesthetic and therefore psychological damage, early treatment can then be considered [7].

Conflict of Interest: The authors declared that they have no conflict of interest.
Grant Information:  The author(s) received no specific funding for this work.
Acknowledgement: The authors have no acknowledgements to declare.