Bilateral Cervical Ribs Research Articles

Cervical Rib Causing Occlusion of the Subclavian Artery and Thoracic Outlet Syndrome

Purpose: To present an unusual case of a cervical rib as a cause of subclavian artery occlusion and thoracic outlet syndrome. Procedures: Case report Results: A 39-year-old female presented to the emergency room with a 2-day history of unilateral headache, facial tingling, and slurred speech, along with a 2-month history of left upper extremity weakness and coolness of the left hand. A stroke workup that included carotid duplex ultrasonography revealed findings suggestive of left subclavian occlusion, later confirmed on CT angiography. Neurologic workup suggested migraine, rather than ischemia, as the cause of headache; however, the subclavian occlusion prompted further investigation, including a chest radiograph that revealed bilateral cervical ribs. The patient was taken to surgery where her left cervical rib was excised and the chronically occluded left subclavian artery was found to have significant post-stenotic dilatation. Given that the chronic nature of her left upper extremity symptoms were not limiting, the decision was made to not undertake bypass. Recommendation was made to remove her right cervical rib prophylactically at a future date. Conclusions: Cervical ribs are a rare cause of vascular thoracic outlet syndrome, with compression leading to post-stenotic dilatation and symptoms of ischemia in the involved extremity.

Cervical rib - a clinical case report

AbstractThe cervical rib is surgically important than being just anatomical curiosity alone. The distal parts of costal processes in seventh cervical vertebra occasionally develop as cervical rib. A 32 years old female patient who attended the vascular surgical department presented with features of cervical rib on the left side. Imaging procedures confirmed bilateral cervical rib for which the patient underwent surgery. The cervical rib can cause thoracic outlet syndrome with features of acute arterial occlusion in upper limb. This case is reported to stress the important complications due to the cervical rib.

Incidental finding of dextrocardia with situs inversus totalis in a day old neonate: Case report and review of the literature

DOI:http://dx.doi.org/10.4314/njp.v41i3,20 Abstract: Dextrocardia with situs inversus are rare congenital anoma- lies which can be asymptomatic and compatible with normal life. They are characterized by mirror images of all intra-thoracic and intra-abdominal viscera. Our aim is to report an incidental finding of dextrocardia with situs inversus in a neonate with neonatal sepsis. A day-old male term neonate pre- sented with features of infection. Physical examination revealed car- diac apex on the 4th right intercos- tal space, along the mid-clavicular line. Chest radiograph and abdomi- nal ultrasound confirmed the diag- nosis of dextrocardia with situs inversus. Bilateral cervical ribs were also seen on chest radio- graph. He was managed with anti- b i o t i c s a n d d i s c h a r g e d . Newborn babies should have a thorough physical examination after delivery before discharge to enable early diagnosis of congeni- tal anomalies for appropriate refer- ral.

Cervical rib - a clinical case report

The cervical rib is surgically important than being just anatomical curiosity alone. The distal parts of costal processes in seventh cervical vertebra occasionally develop as cervical rib. A 32 years old female patient who attended the vascular surgical department presented with features of cervical rib on the left side. Imaging procedures confirmed bilateral cervical rib for which the patient underwent surgery. The cervical rib can cause thoracic outlet syndrome with features of acute arterial occlusion in upper limb. This case is reported to stress the important complications due to the cervical rib.

The significance of cervical ribs in thoracic outlet syndrome

The purpose of this study was to review our operative experience in patients with thoracic outlet syndrome (TOS) resulting from cervical ribs causing clinical symptoms. This study is a retrospective review of a prospectively acquired database of patients with TOS treated with first rib resection and scalenectomy with or without cervical rib resection at the Johns Hopkins Medical Institutions. Between October 2003 and June 2011, a total of 23 cervical rib resections were performed on 20 patients, three of whom had bilateral cervical ribs resected during separate operations. Seven patients presented with subclavian artery thrombosis. Three of seven patients had subclavian artery aneurysms and underwent cervical rib resection through a supraclavicular approach to facilitate subclavian artery bypass. Five patients presented with an ischemic upper extremity without thrombosis and underwent transaxillary first rib and cervical rib resection. Three patients presented with subclavian vein thrombosis; two of the three patients underwent balloon dilation 2 weeks postoperatively for stenosis. Additionally, five patients presented with neurogenic TOS evidenced by pain, numbness, and weakness without vascular compromise in the affected arm. Cervical ribs with bony fusion to the first rib were found in 17 of 23 cases (74%). Cervical ribs causing clinical symptoms are large and frequently fused to the first rib, and can result in aneurysm formation or thrombosis. In our experience, both the cervical rib and the first rib must be removed to relieve arterial compression and can usually be done through a transaxillary approach. Only patients with aneurysms needing arterial reconstruction require resection of the artery from a supraclavicular approach.

Restlessness in right upper limb as sole presentation of restless legs syndrome

Restless legs syndrome (RLS) rarely affects the upper limb during the initial course of disease. We present a patient who complained of symptoms suggesting RLS in the right upper limb as the sole manifestation of illness. Bilateral cervical ribs and depression were co-incidental findings. Patient responded well to dopaminergic therapy.

Cervical Rib: It's Prevalence in Indian Population around Lucknow (UP)

Objective: The study was conducted to know the prevalence of cervical rib in Indian population especially in and around Lucknow and to compare the results with the other study reported in London population.Material and Method: The study was conducted on chest X-rays of 12950 cases done for various complaints of both male and female patients, irrespective of age and ethnicity who attended the Radiology Department of Era's Lucknow Medical College, Lucknow during a period of 7 months, that is from 01-09-2011 to 31-03-2012.Results: An incidence of 0.6% was observed with bilateral cervical rib being more common in both males and females and the incidence of cervical rib in females was 0.73% as compared to 0.49% in males.Conclusion: Indian population showed an overall incidence of 0.6% as compared to the London population showing an overall incidence of 0.74%. Bilateral cervical rib is more common in both male and females and left sided cervical rib being more common in males in comparison to right sided cervical rib in females.

Thoracic outlet syndrome caused by pseudoarticulation of a cervical rib with the scalene tubercle of the first rib

A healthy 20-year-old man presented with a bony lump above the left clavicle associated with upper limb pain, numbness, and tingling. Examination in the surrender position elicited left hand weakness and pain with loss of the radial pulse. The patient had paresthesia of the ulnar border of the left hand but no interossei wasting. A lateral neck radiograph identified an unusual bony contour anteriorly at C7/T1 suggesting a cervical rib (A). Duplex ultrasound scan showed widely patent left axillary and subclavian arteries with the arm adducted but severe compression of the subclavian artery on abducting the arm to 90°. A subsequent computed tomography angiogram confirmed bilateral cervical ribs; the left articulating with an extended left transverse process of the seventh cervical vertebra, extending inferiorly to fuse with the first rib (B and C/Cover). The left subclavian artery passed immediately superior to this bony extension whereas the left vertebral artery lay immediately anterior to the origin of the cervical rib at C7. The right cervical rib was much smaller and not in proximity to the vessels. Intraoperatively, the left cervical rib was found to extend from the C7 transverse process to form a true joint with a hypertrophied scalene tubercle on the first rib; both the cervical rib and hypertrophied scalene tubercle were excised via the supraclavicular incision (D). A T1 sensory and motor neuropraxia was noted day 1 postsurgery which, together with his preoperative symptoms, completely resolved within 5 days and continued at 5-month follow-up. Cervical ribs are a known cause of arterial and neurogenic thoracic outlet syndrome. These congenital abnormalities occur in 1% of the population but are bilateral in 50%. Ninety percent are asymptomatic and do not require resection. Complete cervical ribs occur in approximately 25% of patients, most commonly attached to the first rib by a fibrous band, or more rarely, as in this case, via a true joint, often with the scalene tubercle. Surgical management involves removal of the cervical rib; if this does not provide adequate decompression of the subclavian artery and the brachial plexus, removal of the first rib should be done.

Congenital lower brachial plexus palsy due to cervical ribs

Congenital brachial plexus palsy (CBPP) usually occurs secondarily to intrapartum trauma, but this is not always the case. Cervical ribs have previously been reported to increase the risk of CBPP in association with birth trauma. We report the cases of two children (one female, one male) with congenital lower brachial plexus palsy in whom the presence of non-ossified cervical ribs was the only identified risk factor. In the female child magnetic resonance imaging (MRI) of the brain, spinal cord, and brachial plexus revealed no abnormality except for the presence of bilateral cervical ribs at the level of the seventh cervical (C7) vertebra. Chest radiography was normal, which suggested that the cervical ribs identified on the MRI were fibrous bands or cartilaginous ribs rather than ossified ribs. In the male child, MRI of the spine and brachial plexus was normal but he was noted to have bilateral cervical ribs at C7. These were not identifiable on chest radiography and, therefore, are likely to reflect fibrous bands or cartilaginous ribs.

Fibrotendinous band causing neurogenic Thoracic Outlet Syndrome in adolescent with bilateral cervical ribs

Thoracic Outlet Syndrome (TOS) describes a variety of symptoms caused by the compression of the neurovascular structures in the cervicoaxillary region as they leave the thorax toward the upper limbs. Causes of TOS are vascular and neurogenic, with neurogenic symptoms being the most common presentation (95% of patients). Symptoms related to neurogenic TOS include intrinsic hand muscle and thenar region atrophy and weakness, as well as medial hand and forearm numbness, which are all suggestive of lower trunk involvement. This condition is very rare in the pediatric population. We are reporting a case of true neurogenic TOS caused by a fibrotendinous band in an adolescent with bilateral cervical ribs who was submitted for surgical treatment at the right side.

Cervical Rib causing Thrombosis of Subclavian Atery

We describe here an unusual case of thrombosis of left subclavian artery in a patient with cervical rib. The patient presented with features of ischaemia of left upper limb. X-ray chest revealed bilateral cervical ribs, longer on the left side. Color Doppler studies showed echogenic thrombus within the left subclavian artery. Angiography revealed complete occlusion of left subclavian artery. Embolectomy was done. She was planned for excision of rib.

Anomalias ósseas congênitas em Sotalia guianensis (Mammalia, Cetacea, Delphinidae) da costa centro-norte do Estado do Rio de Janeiro

Carcaças de botos-cinza Sotalia guianensis (van Bénéden, 1864) foram recuperadas entre 20 de agosto de 2001 e 13 de fevereiro de 2006, na costa centro-norte fluminense. A maior parte delas (85%) entre Barra de São João (22º35'S 41º59'W) e Quissamã (22º06'S 41º28'W). Foram estudadas as colunas vertebrais dos 20 exemplares que apresentavam mais de 60% das vértebras presentes. A coleção é formada por 75% de animais imaturos, e todos os esqueletos mostram alterações tafonômicas mínimas. Duas categorias de anomalias congênitas foram diagnosticadas, ambas relacionadas ao desenvolvimento do mesoderma paraxial. A sétima vértebra cervical (C7) foi a única afetada, as costelas cervicais e o não fechamento do arco neural atingiram 15 (75%) dos indivíduos analisados, dos quais três (15%) apresentam ambas as anomalias. Nove (45%) indivíduos apresentaram costelas cervicais uni ou bilateral, e nove (45%) indivíduos apresentaram não fechamento do arco neural; em todos os casos as vértebras contíguas eram normais. A ocorrência de anomalias nesta série do Rio de Janeiro é maior do que as referidas na literatura brasileira para outras séries de Sotalia do Amazonas, Ceará e Santa Catarina. A série de Sotalia descrita vem de uma região do litoral muito limitada e provavelmente representa uma população local. As costelas cervicais são geneticamente determinadas e podem estar concentradas por uma condição de grande proximidade biológica entre os animais; o não fechamento do arco pode ter também um componente ambiental, a ser investigado futuramente.

“Double cervical rib with uncommon presentation”

Double or Bilateral cervical ribs. Pseudo arthrosis of cervical rib with first rib causing neurovascular complication is a rare congenital anomaly. We report a case of young man who presented with intermittent claudication in the right hand and involvement of peripheral nerves. He had bilateral cervical ribs. Left side cervical rib was small. Right side cervical rib had pseudo arthrosis with first rib. There was total occlusion of subclavian artery beyond first part. Abnormal sensation in the inner aspect of hand and fingers. He was managed with subclavian to axillary artery bypass with 6 mm Goretex graft and excision of cervical rib on right side and division of all sclaenus muscles i.e. scelnus anterior, medium minimus with fibrous bands to free subclavian artery and nerves.

Progredient Neurogenic and Vascular Thoracic Outlet Syndrome Due to Bilateral Cervical Ribs

A 26-year-old man who is an airplane technician was admitted to our hospital with a 3-year history of progredient pain, weakening, and paresthesia in his left arm and shoulder, usually during elevation and working overhead on airplane engines. In his seventh year, bilateral cervical ribs have already been diagnosed.

Rare association of hyper IgE syndrome with cervical rib and natal teeth

Hyper IgE syndrome (HIES) is a rare immunodeficiency syndrome characterized by a triad of cutaneous abscesses, mostly caused by Staphylococus aureus; pneumonia; and raised IgE levels. Nonimmunological associations include course facial features, multiple bone fractures, joint hyperextensibility, and retained primary dentition. Patients require long-term antibiotic therapy. We report here a classical case of HIES with rare associations of natal teeth, bilateral cervical ribs, and conductive deafness. The patient was being treated with monteleukast and dapsone.

Complicações arteriais da síndrome do desfiladeiro torácico

As manifestações clínicas da síndrome do desfiladeiro torácico são predominantemente neurológicas, sendo as complicações arteriais raras, mas potencialmente graves. Entre elas, devemos citar os aneurismas com complicações embólicas e a trombose. Os autores relatam o caso de uma mulher de 37 anos com costela cervical bilateral que apresentou embolia no membro superior direito originada de um aneurisma pós-estenótico da artéria subclávia direita, além de apresentar ectasia da subclávia esquerda também por compressão.

Histopathological basis for neurogenic thoracic outlet syndrome

To the best of the authors' knowledge, no report exists that has demonstrated the histopathological changes of neural elements within the brachial plexus as a result of cervical rib compression. Four hundred seventy-five consecutive human cadavers were evaluated for the presence of cervical ribs. From this cohort, 2 male specimens (0.42%) were identified that harbored cervical ribs. One of the cadavers was found to have bilateral cervical ribs and the other a single right cervical rib. Following gross observations of the brachial plexus and, specifically, the lower trunk and its relationship to these anomalous ribs, the lower trunks were submitted for immunohistochemical analysis. Specimens were compared with two age-matched controls that did not have cervical ribs. The compressed plexus trunks were largely unremarkable proximal to the areas of compression by cervical ribs, where they demonstrated epi- and perineurial fibrosis, vascular hyalinization, mucinous degeneration, and frequent intraneural collagenous nodules. These histological findings were not seen in the nerve specimens in control cadavers. The epineurium was thickened with intersecting fibrous bands, and the perineurium appeared fibrotic. Many of the blood vessels were hyalinized. The nerve fascicles contained frequent intraneural collagenous nodules in this area, and focal mucinous degeneration was identified. Cervical ribs found incidentally may cause histological changes in the lower trunk of the brachial plexus. The clinician may wish to observe or perform further evaluation in such patients.

Right supra- Clavicular approach for simultaneous treatment of dysphagia lusoria and cervical rib with scalene node biopsy: A case report

Anomalous origin of aberrant right subclavian artery (ARSA) is a congenital anomaly where symptomatic patients require surgical intervention. It can be associated with other congenital anomalies. A 38-year-old, woman with a 4-year history of progressive dysphagia had bilateral cervical rib and a scalene node. She underwent surgical repair by right supraclavicular approach. She tolerated the procedure well, and was discharged home, symptom free, on postoperative day 4. This approach provides good exposure for simultaneous management of dysphagia lusoria and excision of cervical rib.

The earliest english example of bilateral cervical RIB

The earliest english example of bilateral cervical RIB

TRUE NEUROLOGICAL THORACIC OUTLET SYNDROME: 10 CASES

The thoracic outlet syndrome (TOS) encompasses various clinical entities affecting the neurovascular bundle crossing the thoracic outlet. Unfortunately, this term often proves to be confusing because many of these entities have little in common beyond their known or presumed lesion site. Neurogenic TOS (true TOS) is caused by compression of the lower trunk in the brachial plexus, the cervical ribs or fibrous band. This syndrome is extremely rare. We consider that this neurological form of TOS is a clearly defined neurological syndrome. We report 10 patients with true TOS. All were females. Stating the onset was difficult because symptoms were progressive and insidious. Pain was the most frequently reported symptom. Sensory deficit was slight or absent. All patients showed unilateral severe atrophy of the thenar muscles. Wasting and weakness developed later. A reduced amplitude of ulnar and median compound muscle action potential associated with a normal amplitude of median sensory nerve action and a reduced amplitude of ulnar sensory nerve action potential were indicative of a chronic axon loss in the lower trunk of the brachial plexus. In all cases, we performed medial antebrachial cutaneous sensory nerve action potential, a C8‐T1 innervated nerve. The absence of the medial antebrachial cutaneous sensory nerve action potential in 9 patients and a reduction in amplitude of 50 p. 100 compared to the unaffected side in the other patient indicated the diagnostic value of this easy and reproducible test. It confirmed a C8‐T1 post‐ganglionic radicular lesion or a lower brachial plexus neuropathy. Radiography showed a rudimentary bilateral cervical rib or an elongated C7 transverse process in all cases. Surgery was performed in the affected side in 7 patients and in each case the lower part of the brachial plexus was found to be stretched and angulated over a fibrous band, which was removed. Pain was relieved after 1 to 4 weeks. A minimal motor improvement was observed after one year. Electrophysiological results were unchanged.