Case Report
DOI: 10.5455/2320-6012.ijrms201411113
A rare case of bilateral bifid ribs: a case report
Department of General Surgery, Dr. D. Y. Medical College, Nerul, Navi Mumbai, Maharashtra, India
Received: 11 October 2014, Revised: 25 October 2014
Accepted: 26 October 2014
*Correspondence:
Dr. Sandesh Deolekar,
E-mail: drsandeshdeolekar@gmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Bilateral bifid (bifurcation) rib is very rare malformation of thoracic wall. In this case, we observed variation involving right 6th and left 7th rib in 21 year female. The right 6th and 7th rib and its costal cartilage were bifurcated enclosing a small oval additional intercostal space.
Keywords: Bifid ribs, Rare bilateral bifid costal cartilage, Rib bifurcation, Rib anomaly
INTRODUCTION
Thoracic cage is formed by 12 pair of ribs and sternum, provides support and protection to various viscera in thoracic cavity. Ribs are derived from ventral extension of the sclerotomic mesenchyme that forms the vertebral arches. In thoracic region, the entire extension (called the primitive costal arch) undergoes chondrification, and subsequent ossification, to form the ribs. Common anomalies of ribs include missing/absent rib, Accessory ribs (cervical or lumbar).
CASE REPORT
A 21 year female presented with complaints of swelling in bilateral axillary region since 6 months. There was no history of fever, malaise, weight loss, cough, chest pain, breathlessness, and haemoptysis. No past history of tuberculosis. Clinical suspicion of bilateral axillary lymphadenopathy due to tuberculosis. X-ray chest done to see any evidence of pulmonary tuberculosis. X-ray chest showed right 6th and left 7th bifid ribs [Figure 1 & 2].
DISCUSSION
Bifid ribs are generally incidental findings discovered on chest radiography or during cadaveric dissection.1,2 Usually they are asymptomatic but can be associated with respiratory difficulty or neurological complaints or any chest deformity.4 Patient may present with chest pain, dyspnoea or hemoptysis. It can be seen in Gorlin-Goltz syndrome5 a rare autosomal dominant disorder characterize by multiple nevoid basal cell carcinoma, jaw cyst and bifid ribs.
In a study of forty thousand chest x-rays by etter et al.3 showed that bifid ribs are more common in males and usually unilateral, more common on right side and mostly involving 3rd and 4th rib.
Knowledge of bifid ribs is necessary for differentiating it from other conditions like fracture or tumours of chest wall. Ribs and intercostal spaces are important for surface marking for clinical examination and surgical procedures.
CONCLUSION
Knowledge of this anatomical variation is of utmost important to surgeons performing thoracic surgeries.
REFERENCES
- 1. Song W, Kim S, Park D, Koh K: Bifid rib: anatomical consideration in three cases. Yonsei Med J 2009,50:300-303.
- 2. Osawa T, Sasaki T, Matsumoto Y, Tsukamoto A, Onodera M, Nara E: bifid ribs observed in the third and fourth ribs. Kaibogaku Zasshi 1998,73;633-635.
- 3. Etter LE: Osseous abnormalities of thoracic cage seen in forty thousand consecutive chest photo roentgenograms. Am J Roentgenol 1944, 51:359-363.
- 4. Bloomberg MW: Bifurcate ribs-an unusual cause of deformity of the chest. Can Med Assoc J 1926, 16: 807-808.
- 5. Gorlin RJ, Goltz RW: Multiple nevoid basal-cell epithelioma, jaw cysts and bifid rib syndrome. N Engl J Med 1960;262:908-912.