Specialist Referral for Chest Wall Abnormality Assessment
You should start with your primary care physician or a thoracic surgeon for initial evaluation of a chest wall abnormality, as these specialists are best positioned to coordinate the diagnostic workup and determine if additional subspecialty consultation is needed. 1
Initial Evaluation Pathway
Primary Assessment
- Primary care physicians can initiate the diagnostic workup with history, physical examination, and chest radiography as the first-line imaging test to evaluate for fractures, infections, neoplasms, or structural abnormalities 1
- Thoracic surgeons are the definitive specialists for chest wall pathology, particularly when structural abnormalities, tumors, or complex deformities are suspected 2, 3
Key Clinical Features to Identify
The specialist will assess specific characteristics that guide further management:
- Pain characteristics: Location (retrosternal 52%, left-sided 69.2%), quality (piercing 53%, pressure 35.1%), and whether it varies with respiration, position, or palpation 4
- Structural deformities: Sternal depression/protrusion, rib cage asymmetry, or spinal abnormalities 5, 6
- Red flags: History of malignancy, trauma, infection, or symptoms interrupting normal activity 7
Subspecialty Referrals Based on Findings
When Malignancy is Suspected or Known
- Thoracic surgeons lead management, as chest wall tumors require wide local excision with 4-cm margins for malignant disease 2
- Plastic surgeons collaborate for reconstruction after extensive resections, particularly when skeletal stabilization and soft tissue coverage are needed 3
- Medical oncologists and radiation oncologists provide adjuvant therapy for positive margins 2
For Congenital or Structural Deformities
- Thoracic surgeons perform corrective procedures for pectus excavatum, pectus carinatum, and other chest wall deformities 5, 8
- Plastic surgeons assist with complex reconstructions requiring muscle flaps (pectoralis major, latissimus dorsi, rectus abdominis) 3
- Orthopedic spine surgeons or neurosurgeons manage kyphoscoliosis or ankylosing spondylitis affecting the chest wall 6
For Inflammatory or Infectious Conditions
- Infectious disease specialists manage complex cases of osteomyelitis or post-sternotomy infections 1
- Thoracic surgeons perform debridement when surgical intervention is required 1
Multidisciplinary Team Approach
Complex chest wall abnormalities require coordinated care among multiple specialists 2, 3:
- Thoracic surgery (primary surgical management)
- Plastic surgery (reconstruction)
- Radiology (advanced imaging with CT or MRI for characterization)
- Physical medicine and rehabilitation (functional recovery)
- Pulmonology (respiratory function assessment)
- Critical care (post-operative management)
This team-based approach is essential for extensive resections, complex reconstructions, or cases requiring significant functional restoration 3.
Common Pitfall to Avoid
Do not delay referral to a thoracic surgeon if imaging reveals a mass, structural abnormality, or unexplained chest wall lesion, as early surgical consultation improves outcomes, particularly for malignancies where local control is the most important prognostic factor 2.