{
  "abstract": "An adolescent girl presented with chronic cough and blood in vomitus, which was dark brown, scanty in amount, with one episode every week for the past 6 months. The cough was dry, with nocturnal worsening, more when she lies in the supine position, associated with retrosternal chest pain and dysphagia. There was also a history of progressive decreased chest size on the left side, as noticed by the mother since early childhood, progressing and presenting with visible asymmetry of breast size. There was no history of foreign body aspiration, tuberculosis contact, bleeding diathesis or family history of asthma/similar illness. Her menstrual and personal histories were unremarkable. On examination, she had pallor and severe thinness (Body Mass Index = -4 z), with stable vitals. Respiratory examination showed a decreased scapular prominence, underdeveloped breast and an inverted nipple on the left side, less prominence of left scapular border in comaprson to right side ( figure 1). Other systemic examinations and sexual maturity rating stages were normal. The differential diagnoses were missed foreign body, congenital lung or arterio-venous malformations and aspiration syndromes (H-type fistula, or severe gastro-oesophageal reflux disease). The haemogram was unremarkable except for microcytic hypochromic anaemia (8.6 g/dL). The coagulation profile and other biochemical parameters were normal. Chest X-ray demonstrated a relatively decreased breast shadow prominence and crowding of ribs on the left side (figure 2A). The bronchoscopy and bronchoalveolar lavage investigations were unremarkable. Upper gastrointestinal endoscopy revealed a sliding hiatal hernia (HH) with Hill’s grade 3 (figure 2B). A chest CT demonstrated a hypoplasia of pectoralis major muscle and breast tissue, confirming Poland syndrome (PS). A final diagnosis of PS with sliding hiatus hernia was made. Her symptoms were progressing, even with proton pump inhibitors along with antacids, and hence, she was planned for Nissen fundoplication.",
  "authors": [
    {
      "affiliations": [
        "Paediatrics, All India Institute of Medical Sciences Jodhpur, Jodhpur, RJ, India"
      ],
      "name": "Kkomal C Suvarna"
    },
    {
      "affiliations": [
        "Paediatrics, All India Institute of Medical Sciences Jodhpur, Jodhpur, RJ, India"
      ],
      "name": "Kalyana Prabhakaran"
    },
    {
      "affiliations": [
        "Paediatrics, All India Institute of Medical Sciences Jodhpur, Jodhpur, RJ, India"
      ],
      "name": "Jagdish Prasad Goyal"
    },
    {
      "affiliations": [
        "Paediatrics, All India Institute of Medical Sciences Jodhpur, Jodhpur, RJ, India"
      ],
      "name": "Prawin Kumar"
    }
  ],
  "title": "Asymmetrical chest wall presenting with haematemesis: a clinical dilemma",
  "uid": "88dba98e-e413-5dbe-a30c-a71e6f3a375d"
}