An unusual cause of “traumatic” hemothorax: perforation of the lung parenchyma by a bifid rib

Abstract

Congenital anomalies of the ribs are relatively common, and they can be divided in numerical (for example cervical ribs) or structural abnormalities (for example bifid ribs). These anomalies are usually asymptomatic. Literature on symptomatic bifid ribs is limited. We present the case of a 36-year old male without any relevant medical history or medication who was referred to our center. After lifting a heavy object, he experienced sudden onset pain on the right anterior chest, with associated shortness of breath. Computed tomography of the chest showed a significant hemothorax on the right side, compression atelectasis of the right lower lobe, and an anomalous fifth right rib – described as a bifid rib. A VATS resection of the bifid rib was performed.The images of this case illustrate the unusual traumatic perforation of the lung caused by a bifid rib. The case illustrates that one might consider resection of an asymptomatic bifid rib when imaging suggests significant compression on the lung parenchyma.