Bilateral Cervical Ribs Research Articles

A Case of Arterial Thoracic Outlet Syndrome Thrombus Extending to Juxtavertebral Artery

Arterial thoracic outlet syndrome (TOS) constitutes less than 1%, involving the second part of the subclavian artery (SCA). It can present as an acute upper limb ischemia or aneurysm formation. Here is a case of a 29-year-old male presented with complaints of rest pain over the left hand for the past 2 weeks. Upon evalution, found to have bilateral cervical rib with left subclavian artery occlusion. Treated by cervical rib excision decompression of scalene triangle, subclavian endarterectomy and left brachial embolectomy. Arterial TOS secondary to the cervical rib is rare; pathology involving this external compression results in repeated trauma in the intima of the SCA, resulting in subclavian stenosis, poststenotic dilatation, thrombosis, and aneurysm formation with mural thrombus and distal embolization. Symptomatic cases need decompression +/- arterial repair.

Neglected Sprengel’s deformity in an 80-year-old female cadaver: a case report

BackgroundSprengel’s deformity is a congenital abnormality of the shoulder girdle. Because scapular retraction, such as the Green procedure, is usually performed during childhood to improve esthetics and shoulder function, Sprengel’s deformity is rarely found in older patients.Case presentationWe presented a unique case of a Japanese female cadaver with Sprengel’s deformity at the age of 80 years. Anatomical dissection and radiological imaging revealed musculoskeletal anomalies associated with Sprengel’s deformity, including Klippel–Feil syndrome, presence of an omovertebral bone, and absence of the trapezius muscle. In addition, bilateral cervical ribs were in contact with the brachial plexus. These anomalies may lead to numbness, pain, and limited range of motion of the neck and upper girdle with aging.ConclusionsBecause most adult patients with Sprengel’s deformity experience neck pain and limited movement of the shoulder, the presented case is a rare case of neglected Sprengel’s deformity in an 80-year-old cadaver.

Retrograde thromboembolism and recurrent stroke in an adolescent boy with bilateral cervical rib.

Retrograde thromboembolism and recurrent stroke in an adolescent boy with bilateral cervical rib.

Bilateral Cervical Ribs Fusing or Naffziger Syndrome: About an Observation in Guinea and Literature Review

Bilateral Cervical Ribs Fusing or Naffziger Syndrome: About an Observation in Guinea and Literature Review

Boney abnormalities cause arterial, venous, and/or neurogenic thoracic outlet syndrome.

Thoracic outlet syndrome (TOS) is a rare condition caused by compression of the neurovascular structures within the thoracic outlet. Different classifications of TOS exist depending on the neurovascular structure being compressed: neurogenic, venous, or arterial. Any of these forms can present independently or coexist with one other. TOS symptoms are sometimes precipitated by the presence of boney abnormalities that often require surgical intervention for ultimate resolution. This retrospective review will examine the presentations and outcomes of patients with TOS whose cause was a boney abnormality. A total of 73 patients who underwent thoracic outlet surgery between 2016 and 2021 were retrospectively reviewed via electronic medical records. Twelve (16%) patients demonstrated boney abnormalities on presentation causing their symptoms. The patients with boney abnormalities were analyzed based on venous, arterial, or neurogenic TOS diagnosis. Of the 12 patients with boney abnormalities, 5 were classified as venous TOS, 6 patients as neurogenic TOS, and 1 as arterial TOS. The boney abnormalities were as follows: venous TOS: three clavicular fractures, one nonfused congenital clavicle, and one residual rib; neurogenic TOS: three fractured first ribs, one fractured clavicle, and two cervical ribs; and arterial TOS: fused first and second rib with bilateral cervical ribs and arterial compression. Postoperatively, there were no artery, vein, or nerve injuries. Five patients had a pneumothorax treated over night with a chest tube, and one patient had a superficial wound infection. The median hospital stay was 1day. All patients completed physical therapy after surgery. All patients have symptom resolution at follow-up. Patients with boney abnormalities constitute about one-fifth of patients who can present with all three forms of TOS: neurogenic, arterial, and venous, and some will have more than one of these presentations. Results in patients undergoing surgery with boney abnormalities causing thoracic outlet syndrome are excellent with symptom resolution and without substantial complications.

Think About Klippel–Feil as Causing Neurogenic Thoracic Outlet Syndrome!

A 49-year-old woman presented with bilateral symptomatic neurological and arterial thoracic outlet syndrome. Computed tomography angiography revealed bilateral cervical ribs (black arrows), synostosis with the first right rib (B,*), and a post-stenotic dilatation of the right subclavian artery (A, white arrow). The presence of a supernumerary hemi-vertebra at the cervicothoracic hinge and fused C6 – C7 cervical vertebrae (star) supported the diagnosis of Klippel–Feil syndrome. Transaxillary resection of the cervical and first ribs and scalene muscles was first performed on the right.

Pseudohypoglycaemia in a case of bilateral cervical rib.

Pseudohypoglycaemia in a case of bilateral cervical rib.

OA17 An evolving case of Anti PM/Scl Anti body associated Aggressive Systemic Sclerosis

OA17 An evolving case of Anti PM/Scl Anti body associated Aggressive Systemic Sclerosis

Frequency of Cervical Ribs in Healthy Asymptomatic Adolescents and Adults, Detected on Chest Radiograph for Medical Fitness Examination at CMH Lahore

Objective: To determine the frequency of cervical ribs on chest radiographs of asymptomatic candidates undergoing medical fitness.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Radiology Department Combined Military Hospital Lahore Pakistan from Feb 2020 to Mar 2021.
 Methodology: The study was conducted on 4247 chest radiographs of candidates who reported to CMH Lahore for medical examination. The latest chest radiographs of candidates reporting for medical examinations in the CMH Lahore were included. Technically poor radiographs were excluded.
 Results: The frequency of cervical ribs was 136 (3.2%) with 14 (5.6%) females and 122 (3.1%) male cases. Among cervical ribs cases, 85 (62.5%) were bilateral, and 51 (38%) were unilateral. Among unilateral cervical ribs, 28 (55%) were right-sided, and 23 (45%) were on the left side.
 Conclusion: The frequency of cervical ribs is comparatively higher than in most international studies. The frequency of bilateral cervical ribs and type 4 cervical ribs are higher in females than males.

Incidence and Clinical Implications of Cervical Rib: A Retrospective Study

Introduction: Cervical ribs are an additional rib, which arise from the costal element of the seventh cervical vertebra. Incidence varies from 0.58-6.2%, incidentally detected on radiographs, but when enlarged can lead to various vascular and neurological symptoms. When it is of sufficient length it can compress the neurovascular bundle leading to Thoracic Outlet Syndrome (TOS) causing vascular and neurological symptoms. Aim: To determine the incidence and morphology of cervical rib in a convenient sample. Materials and Methods: A retrospective observational study was done in 650 radiographs (356 males and 294 females) from January 2016 to January 2019 and the study was conducted at ESIC Medical College and PGIMSR, Chennai, Tamil Nadu, India, and the data was analysed for the incidence and morphology of cervical ribs. Results: Incidence of cervical ribs in females (1.7%) was higher than males (1.12%). In the present study, incidence of cervical ribs was 1.38%, we observed there were seven cases of bilateral cervical ribs and two cases of unilateral cervical rib. Morphologically, cervical ribs had head, neck and tubercle and articulated posteriorly with transverse process and no other significant morphological variations were seen. Conclusion: Knowledge regarding incidence of cervical ribs and other rib anamolies assists the radiologist and surgeons in early diagnosis and management of symptomatic patients in order to avoid neurovascular complications.

Cervical rib, case series from a university hospital of Nepal

Cervical rib is a rare anatomical anomaly with an incidence of 0.2%–1% and is an important cause of thoracic outlet syndrome. We present a case series of five female patients with a mean age of 20.6 (15–26) years, symptoms present were neck pain, neck mass, tingling sensation and weakness in the affected side. Symptoms develop in adolescence probably due to sagging of the shoulders and a disproportion between chest and neck growth at this age. X-rays of cervical spine was a common mode of diagnosis and showed bilateral cervical rib in three cases and unilateral in two cases. They were managed by performing surgeries under supraclavicular approach with resection of cervical rib of affected side. There was improvement of symptoms with restoration of limb function with a mean time of recovery of 9 weeks. Early diagnosis is important as differential diagnosis of such symptoms may be cervical stenosis and myelopathy which differ in management and have a greater risk of morbidity. In absence of intervention, cervical ribs can lead to compression of neurovascular structures leading to worsening of symptoms, thrombosis of subclavian artery or cerebral emboli.

Poland's syndrome with dextroposition and paradoxical breathing.

An asymptomatic 60-year-old woman presented to our outpatient clinic for a routine health screening as part of a government welfare program. Her medical history was unremarkable, however physical examination revealed hypoplasia of the left chest wall muscles, breast tissue, nipple, absence of axillary hair, absence of the costal cartilages of upper ribs on the left side of the chest and brachydactyly in the left hand. There was also paradoxical breathing at the levels of the 2nd, 3rd and 4th rib of the left chest. The rest of the examination was unremarkable. The chest radiograph revealed reduced upper left hemithorax volume with partial rib agenesis of the 2nd, 3rd and 4th rib, bilateral cervical ribs, dextroposition of the heart and mid thoracic scoliosis with convexity to the left. A 12-lead electrocardiogram revealed a sinus rhythm with a normal axis, lead 1 has upright P, QRS, and T waves and aVR is globally negative. The precordial leads show normal R Waves in V1-4, deep S waves in V1-2, small S waves in V3-4 and no S waves in V5-6. There is diminution of the precordial complexes in V3, 4, 5 and 6. These findings are consistent with a dextroposition of the heart. The blood investigations were unremarkable. The findings from physical examination, chest radiograph and 12 lead electrocardiogram are consistent with Poland's Syndrome. As the patient was otherwise well and not bothered by her condition, no treatment was initiated for her.

Cervical ribs in human early life: morphological variability and first identification as a morbidity criterion in a past population.

Despite the medical literature on supernumerary cervical ribs in extant adult samples, little is known about their development and occurrence in early infancy. The documentation of cervical ribs in modern samples of fetuses and neonates is indeed affected by ethical as well as technical limitations. The aim of the present study was to investigate their frequencies and morphological variability in the first known archaeological collection of very young children with this anatomical variant. The study sample comes from the 8B-51 necropolis on the Saï island (Sudan) and dates to the Classic Kerma Period (XVIIIe-XVIe centuries BC). It consists of 64 individuals deceased between 24weeks of amenorrhoea and 2years of age. Bilateral or unilateral cervical ribs were found in 27 individuals. A total of 43 cervical ribs were identified, 38 of which are fully preserved. According to these observations, at least 42% of the individuals have unilateral or bilateral cervical ribs, with an average maximum length of < 1 cm. This frequency is very high compared to those observed in contemporary adult samples (up to 3%). First, the comparison of our results with biological and genetic research demonstrating the link between the occurrence of cervical ribs and a reduced chance of survival during infancy allows the first identification of this trait as an indicator of morbidity in an archaeological collection, a morbidity to which a genetic homogeneity or even endogamy could contribute. Second, the number of ribs studied makes it possible to propose a morphological classification based on the general shape and the shape of the articular facets, classification that can be used tos refine the analyses of the trait in future samples.

Subclavian carotid transposition: A single-center experience

Objective: Subclavian carotid transposition (SCT) is generally performed for stenoocclusive disease of the proximal subclavian artery. This study was undertaken to analyze the results of SCT at our center and also highlight the usefulness of this procedure in varied pathologies involving the proximal subclavian artery. Patients and Methods: This retrospective study included 16 consecutive patients from 2011 to 2016 who presented to our department. The study was carried following approval by the Institute Research Committee and the Institute Ethics Committee. The data were collected from the departmental database, and the patients were followed up prospectively and the data were analyzed. Results: The mean age of the patients at presentation was 46.6 years with standard deviation of 11.48. Eleven patients (78%) had total occlusion of the proximal subclavian artery. About 81% of the patients had left-sided SCT. The etiology for SCT was varied with ten patients (62.5%) having proximal subclavian artery occlusion with chronic upper-limb ischemia, three patients (18.75%) with acute subclavian artery occlusion, one patient with bilateral cervical ribs, one patient with dysphagia lusoria with aberrant right subclavian artery (ARSA), and one patient with right common carotid aneurysm. The mean follow-up duration was 64 months. The patency rate was 100% in the study population. There were no immediate occlusions or stenosis noted in our series. Conclusion: SCT is a safe, effective, and durable procedure with long-term patency rates with less morbidity and reintervention rates. It can be safely done for both acute and chronic subclavian artery occlusions and various other conditions too such as dysphagia lusoria due to ARSA and cervical rib with subclavian artery occlusion. Hence, a vascular surgeon should master the art of doing SCT for its good results and for its being effective for varied pathologies.

Transaxillary decompression of thoracic outlet syndrome: A single-center study

Objective: Transaxillary approach for the surgical management of thoracic outlet syndrome (TOS) has the advantage of minimal manipulation of brachial plexus and lesser perioperative and postoperative complications. We studied the clinical presentation and transaxillary surgical excision of the first rib in TOS at our center. Materials and Methods: All patients with TOS were reviewed for their clinical presentation and outcomes of transaxillary approach for thoracic outlet decompression over a period of 10 years. We evaluated the clinical presentation, surgical details, and postoperative course of all patients who underwent surgery. Results: Sixty-three patients of TOS were studied who underwent decompression through transaxillary approach over a period of 10 years. Nearly 79.4% of the patients had neurological symptoms, whereas 20.6% had arterial symptoms. Almost all patients (98.4%) had a cervical rib. One-fourth of the study population had bilateral cervical ribs. Around 17.46% of the patients presented with acute thromboembolism of the brachial artery and were managed with emergency thromboembolectomy. Postoperative complications encountered were pleural breach (11.11%), wound infection (7.94%), and re-thrombosis (1.59%). Conclusions: Transaxillary resection of the cervical/ first rib has excellent results, with less morbidity. It is efficient in relieving symptoms and gives cosmetically acceptable scar. It is proposed that whenever any patient presents with acute upper-limb ischemia, he/she must be evaluated for cervical rib as a cause of TOS.

Bioarchaeological evidence of care provided to a physically disabled individual from Pachacamac, Peru

This paper presents a bioarchaeology of care case study based on the skeletonized remains of an elderly female with a congenital condition that compromised both mobility and independence in undertaking certain basic tasks, and which generated requirements for long-term care in the form of both direct support and accommodation. The remains show evidence of bilateral cervical ribs, severe osteoarthritic destruction in the right shoulder joint, and a healed skull trepanation. The remains were recovered from a cemetery dating to the initial part of the Late Intermediate Period at the archaeological site of Pachacamac, Peru. The subject has been identified as belonging to an Ychsma ayllu. This paper applies the bioarchaeology of care methodology in considering the implications of care provision within the Ychsma socialcontext, and suggests that caregiving may have been a relatively common practice in this complex society. This case study is a good example of how the application of social theory through the bioarchaeology of care approach can enrich bioarchaeological studies.

A study of clinical profile of hypospadias cases at a medical college hospital of South Gujarat, India

Background: Hypospadias is a common congenital anomaly in which the anterior urethra is incompletely developed and does not extend to the tip of the glans penis. The present study was aimed to study clinical profile of hypospadias cases at a medical college hospital of southern Gujarat.Methods: This prospective study was conducted at a tertiary care hospital of South Gujarat, India including 32 patients of hypospadias. Data collected for each patient included age, sex, demography, and major symptoms, duration of symptoms and relevant past and treatment history.Results: Out of 32, 9 (28%) patients are between 4 years to 6 years of age and mean age of presentation of patients of hypospadias is 7.55 years. Twenty seven (84%) patients of Hypospadias were associated with prepucial hood, 17 (53%) patients of Hypospadias were associated with meatal stenosis, 6 (19%) patients of hypospadiasis were associated with severe chordee and 2 (6%) patients associated with narrow urethral plates.Conclusions: T Most cases of hypospadias were presented at age 9 years and below. Most common type of hypospadias was coronal and distal penile followed by penoscrotal type. Hypospadias was associated with prepucial hood (84%), meatal stenosis (53%), Chordee (19%) and narrow urethral plates (6%) out of total cases. Hypospadias was associated with undescended testis, bilateral retractile testis, cervical rib, mental retardation and microcephaly with mental retardation, squint and bifid tongue.

Prevalence of Cervical Rib in Western Nepal

Introduction: Cervical rib is usually asymptomatic. It is usually detected incidentally when radiograph is done for other reasons. Cervical rib has been found to be symptomatic in about 10% of cases. This study was carried out to evaluate the prevalence of cervical ribs and percentage of symptomatic patients among Nepalese population in western development region.Methods: Total of 3600 chest and cervical spine radiographs of patients done for various purposes in radiology department were evaluated for presence of cervical rib. Study was carried out during September 2013 to February 2014. Patients of 16 years and above were included in the study. History was also noted to see if patients with cervical rib were symptomatic. SPSS version 17 software was used in data analysis.Results: Prevalence of cervical ribs was found to be 1.1 % with higher rate in females. Among 39 patients with cervical rib; bilateral cervical ribs was seen in 46.2 %. Cervical rib was more common on right side, seen in 38.5 % of cases. It was seen on left side in 15.4 % of cases. Cervical rib was found to be symptomatic in 10.25 % of patients. Among them; two patients presented with pain in arm and other two presented with hard swelling in right cervical region.Conclusion: The cervical rib is common in our population. Patients with pain, numbness in arm and swelling in cervical region should be evaluated for cervical rib.

Critical Upper Limb Ischemia due to Subclavian Artery Compression Caused by Initially Undiagnosed Cervical Rib - A Case Report

True subclavian artery aneurysms are relatively rare events. Thoracic outlet compression is responsible for 75% of those aneurysms. They are formed as a result of compression of subclavian artery, for example a cervical rib. A case of subclavian artery aneurysm secondary to cervical rib in a 35 year old young adult, who presented with a critical ischemia in his dominant right upper limb. Plain x-ray of cervical spine revealed bilateral cervical ribs and duplex study of the both upper limb arteries concluded aneurysmal dilatation of mid-distal subclavian artery of both sides with mural thrombus on the right side, marked distal ischemia in the right upper limb due to occlusive thrombus in the distal arterial tree, normal distal arterial flow in the left upper limb. Although it is a rare lesion, cervical rib leading to thoracic outlet compression should always be included in the differential diagnosis of a critically ischemic limb in young age group. Surgical management should be considered in a patient with subclavian artery aneurysm due to cervical rib to prevent additional embolic events.University Heart Journal Vol. 11, No. 1, January 2015; 48-51

Costoclavicular Syndrome and MRI Evaluation, Our Experience at Tertiary Care Hospital, SKIMS Srinagar, J&amp;amp;K

Introduction: Cervical rib is a supernumerary rib springing from one of the cervical vertebrae, usually the seventh. About 1 in 200 people are born with cervical rib. About 1 in 10 people who have a cervical rib develop symptoms of thoracic outlet syndrome (TOS). Aims: The aim of this study was to identify normal and abnormal anatomy of thoracic outlet using MRI in symptomatic costoclavicular compression syndrome and to plan them for surgery thereafter. Methods: This was a prospective hospital based study. All the symptomatic cases of cervical rib syndrome admitted in the department of Cardiovascular and thoracic surgery SKIMS, Srinagar from May 2011 to May 2015 were taken up for the study. Results: A total of 40 cases of symptomatic cervical rib syndrome were reported from May 2011 to May 2015. Mean age of presentation was 26.3. The most prevalent age group was 21 - 30 years (47%). Majority of patients were females (83%) with male female ratio of 1:5. 67% had bilateral cervical rib, more in females (72%) than males (40%). 97% had neurogenic thoracic outlet syndrome and 3% had vascular thoracic outlet syndrome. 35% of cases with neurogenic thoracic outlet syndrome had subclavian artery compression on MR Angio of thoracic outlet after subjecting them to postural maneuvers. All the patients with subclavian artery compression were subjected to surgery. Conclusion: Costoclavicular compression syndrome affects mainly young females. MR Angio is complementary in finding vascular compression in cases presenting mainly with neurogenic symptoms of thoracic outlet syndrome.