Sonographic Evaluation of Injuries to the Pectoralis Muscles

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Sonographic Evaluation of Injuries to the Pectoralis Muscles

Amer Rehman and Philip Robinson

Leeds Teaching Hospitals, St. James University Hospital, Chancellor Wing, Beckett St., Leeds LS9 7TF, England.

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Fig. 1A. —Normal anatomy. Drawing of pectoralis major muscle with three heads converging to form lamina and tendon (asterisk).

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Fig. 1B. —Normal anatomy. Longitudinal extended-field-of-view sonogram shows abdominal head of pectoralis major muscle (asterisks) originating from lower ribs and intervening fascia (arrows).

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Fig. 1C. —Normal anatomy. Transverse sonogram shows origin of sternal head of pectoralis major muscle (P) and enclosing echogenic aponeurosis (arrowheads), also adherent to sternum (S).

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Fig. 1D. —Normal anatomy. Transverse oblique extended-field-of-view sonogram shows sternal muscle head of pectoralis major muscle (P) extending from sternum (S), converging to distal myotendon (arrowheads), and inserting into humerus (H).

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Fig. 1E. —Normal anatomy. Sagittal extended-field-of-view sonogram of chest wall shows abdominal (Ab), sternal (S), and clavicular (C) muscle heads of pectoralis major muscle. Pectoralis minor (PMi) muscle lies deep relative to sternal and clavicular heads.

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Fig. 2A. —41-year-old male patient who suffered forced external and abduction injury to left arm when falling down manhole. Transverse oblique extended-field-of-view sonogram shows grade 3 tear with retracted and echogenic (due to fat infiltration) sternal muscle belly (P) and subacute hematoma (asterisk) adjacent to humerus (H). Note intervening linear echogenic structure (arrowheads) that extends over hematoma inserting into humerus deep relative to deltoid (D). Proximal aspect of this structure did not contract on dynamic imaging and was presumed to be scar tissue.

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Fig. 2B. —41-year-old male patient who suffered forced external and abduction injury to left arm when falling down manhole. Axial T1-weighted MR image of left chest wall at same level as A shows retracted sternal head of pectoralis major muscle (P) with some fatty infiltration present. It is difficult to differentiate chronic hematoma of tendon from overlying deltoid (D) at level of humerus, but intervening scar tissue can be identified (arrowheads).

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Fig. 2C. —41-year-old male patient who suffered forced external and abduction injury to left arm when falling down manhole. Corresponding intraoperative photograph shows intact distal tendon (arrowhead) with proximal scar tissue extending along border of subcutaneous fat (arrows).

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Fig. 3A. —26-year-old male badminton player who had forced abduction and external rotation (ABER) of right arm after fall during competition. Transverse extended-field-of-view sonogram shows proximal sternal head of pectoralis major muscle (P) with grade 3 tear of distal myotendon (arrowheads) and acute hematoma (asterisks).

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Fig. 3B. —26-year-old male badminton player who had forced abduction and external rotation (ABER) of right arm after fall during competition. Transverse oblique sonogram shows partial (grade 2) tear (arrows) of distal clavicular head myotendon with hematoma (asterisk).

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Fig. 3C. —26-year-old male badminton player who had forced abduction and external rotation (ABER) of right arm after fall during competition. Sonogram of same region (B) with arm in ABER position shows elongation of hematoma (asterisk) at its margins (arrows) with surrounding muscle myotendon remaining intact, confirming grade 2 injury.

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Fig. 4. —38-year-old male patient who suffered forced external rotation and abduction injury to left arm while trying to stop a rifle from falling. Longitudinal extended-field-of-view sonogram of sternal head of pectoralis major muscle (P) under active contraction shows grade 3 tear at distal myotendon with intervening hematoma (asterisks). Distal tendon (arrowheads) is heterogeneous but intact, inserting into humerus (H) deep to overlying deltoid (D).

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Fig. 5. —45-year-old male patient with hemophilia who presented with chest wall swelling after lifting injury. Sagittal oblique extended-field-of-view sonogram shows normal pectoralis major muscle (asterisk). Pectoralis minor muscle (Mi) is swollen and heterogeneous, especially at its proximal myotendinous origin (arrowheads) at coracoid process (Co), with hypoechoic hematoma (arrow) occupying 50% of myotendon, indicating grade 2 tear.

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Fig. 6. —26-year-old female patient with acute central chest pain after fall involving forced external rotation and abduction of right arm. Transverse extended-field-of-view sonogram obtained at level of sternum (S) shows asymmetry between right (R) and left (L) sternal origins of pectoralis major (see Fig. 1B). Note normal left-sided muscle and enclosing echogenic aponeurosis (arrows). In comparison, right-sided aponeurosis (arrowheads) is ill-defined, displaced, and hypoechoic (edematous). Diagnosis was partial (grade 2) muscle injury with acute muscle hematoma (asterisk).

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