Background: Straight Back Syndrome (SBS) is the absence of normal dorsal curvature in the thoracic part of the spine, resulting in reduced AP diameter of the chest causing compression of the heart and great vessels.

Case Characteristics: 14-year-old Male child complains of chest pain. CVS-Pectus excavatum, S1,S2 normal; Pulmonary area-S2 wide, fixed/ejection systolic murmur, Grade-3/6.

Observation: Chest X-ray:Prominent main Pulmonary artery, loss of normal thoracic kyphosis, narrowing of AP diameter.

Outcome: The murmur provisionally thought to be from an ASD was diagnosed to be flow murmur of SBS.

Message: Murmurs in Pulmonary area associated with pectus excavatum should arise a suspicion of a murmur of SBS.

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Dr C Sai Suveer Reddy

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