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Neonate with a chest wall abnormality

We describe the case of a full-term boy, weighing 3390 g, born by normal delivery, with no relevant pregnancy or family history. His Apgar score was 9/10. On clinical examination, he was in good general condition and there was no respiratory distress. However, he presented thoracic paradoxical movements within the breathing cycle. The hemithoraces were approaching during inspiration and pushed apart during expiration (Fig. 1). The beating heart was visible through the skin. Apart what was referred, no other clinical signs were found. What is the diagnosis? (Answer on page 1116)