Clinical Images  |   July 2020
Straight Back Syndrome
Author Notes
  • From the University of Florida College of Medicine-Jacksonville, Department of Internal Medicine and Department of Radiology in Jacksonville, Florida. 
  • Financial Disclosure: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Julio C. Perez-Downes, DO, 4500 San Pablo Rd S, Jacksonville, FL 32224 Email:
Article Information
Imaging / Neuromusculoskeletal Disorders / Pediatrics / Clinical Images
Clinical Images   |   July 2020
Straight Back Syndrome
The Journal of the American Osteopathic Association, July 2020, Vol. 120, 485. doi:
The Journal of the American Osteopathic Association, July 2020, Vol. 120, 485. doi:
A 33-year-old man with a history of hypertension presented to the hospital with a hypertensive emergency. Physical examination revealed a heart rate of 95 beats/min; blood pressure, 216/149 mm Hg; a 3/6 systolic murmur at the second intercostal space on the left, and a limited range of motion of the thoracic spine. Chest computed tomography revealed cardiomegaly, an anteroposterior thoracic diameter of 8.92 cm at the level of T8, and a lateral diameter of 29.8 cm at the level of the diaphragm. These findings were consistent with straight back syndrome (SBS; image A and image B).1 
SBS is a congenital condition found incidentally during physical and radiographic evaluation. Diagnostic criteria include a ratio of the anteroposterior to the transverse diameter of less than or equal to 1:31 or a distance of 1.2 cm between the middle of the anterior border of T8 to a vertical line connecting T4 to T12 (image C).2 A pulmonic stenosis murmur was noted, presumed to be caused by compression of the right ventricular outflow tract by the SBS.3 Osteopathic manipulative treatment, such as high-velocity, low-amplitude techniques, may be used to improve somatic dysfunctions associated with this condition.3 No specific treatment is indicated. 
Jr DeLeon AC, Perloff JK, Twigg H, Majd M. The straight back syndrome: clinical cardiovascular manifestations. Circulation. 1965;32:193-203. doi: 10.1161/01.cir.32.2.193 [CrossRef] [PubMed]
Davies MK, Mackintosh P, Cayton RM, Page AJ, Shiu MF, Littler WA. The straight back syndrome. Q J Med. 1980;49(196):443-460. [PubMed]
Gordon CJ, Cox JP. Straight back syndrome: report of case. J Am Osteopath Assoc. 1983;83(4):317-320. [PubMed]