Bifurcated rib as major diagnostic criteria of Gorlin syndrome in paediatric patient: a rare case report

Abstract

Background: Bifurcated rib or Bifid rib is considered to be an anatomical overgrowth anomaly of the chest wall, forming a forked sternal end. Diagnosis of this condition is generally an incidental finding on imaging or post-mortem examination. Most of the cases were asymptomatic and established as part of Gorlin syndrome. Here we describe a rare case of chest wall deformity in a paediatric patient, and our approach for this case with limited cost and resources. Case Presentation: A 5-year-old boy, presented at orthopedic outpatient clinic with complaint of a painless lump in his upper left chest. No significant history of infection, malignancy or any congenital syndromes. Chest imaging revealed a bifid left 4th rib at the sternal end. Conclusion: There is currently no data on the best approach to managing bifid ribs. In addition, genetic testing for susceptible genes should be strongly considered. In this situation with limited cost and resources, we suggest close monitoring with regular follow-ups for the patient as the best approach, including detection of any other diagnostic criteria of Gorlin syndrome, to ensure better prognosis and quality of life for this patient.