Sonographic findings of pectoralis major tears with surgical, clinical, and magnetic resonance imaging correlation in 6 patients

Objective. The purpose of this research was to describe the sonographic findings of pectoralis major injuries with clinical, surgical, and magnetic resonance imaging (MRI) correlation. Methods. Images from sonographic examinations of the pectoralis major muscle of 6 patients were retrospectively evaluated and characterized. The sonographic findings were compared with clinical, surgical, and MRI findings. Results. The 6 patients were male (mean age, 30 years) with injuries sustained during weight lifting, football, and shotgun firing. Two of the 6 patients had MRI correlation; 1 had surgical correlation; 2 had both surgical and MRI correlation; and 1 had clinical follow-up. The sternal head was injured in 5 patients; 4 involved the musculotendinous junction, and 1 involved the distal tendon. The sonographic findings of muscle fiber retraction and surrounding hemorrhage allowed identification of the affected muscle. Direct impact injury causing hematoma involved the clavicular head in 1 patient. In total, 5 cases were partial-thickness pectoralis major tears, whereas complete distal tendon disruption was found in 1. Conclusions. Sonographic imaging longitudinal to the pectoralis muscle fibers showed fiber disruption, retraction, and possible hypoechoic or anechoic hematoma, most commonly involving the musculotendinous junction of the sternal head. Distal tendon assessment is important to evaluate for a full-thickness pectoralis major tear.