What is the most likely diagnosis?

• 33 year-old male with back asymmetry

Frontal radiograph of the chest

1. Left lower lobe atelectasis
2. Scimitar syndrome
3. Cleidocranial dysplasia
4. Metastatic disease
5. Sprengel's Deformity

Additional Image - Close-up of right shoulder

 

 

Additional Images

 

Close-up of right shoulder

Answer:

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5. Sprengel's Deformity

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Sprengel's Deformity

General Considerations

• Most common congenital abnormality of the shoulder
• Failure of normal descent of scapula from initial mid-cervical position to final thoracic position
• Descent should occur between sixth and eight weeks gestation
• Can occur unilateral or bilateral
• If unilateral more common in left shoulder
• Often occurs as part of Klippel-Feil Deformity (fusion of cervical vertebrae) 
• Also can occur with absent or fused ribs, chest wall asymmetry, cervical ribs, and/or congenital scoliosis

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