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.