To cite: Chattranukulchai P, Luengtaviboon K, Tumkosit M. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013010389 DESCRIPTION A 38-year-old man with asymptomatic chest wall deformity presented with acute, severe retrosternal pain experienced while he was bowling. The pain radiated to the back and down to abdomen in a tearing fashion. Physical examination reveal...