Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 8  |  Issue : 5  |  Page : 670-671  

Bifid rib: A rare anomaly


Department of Anatomy, Armed Forces Medical College, Pune, Maharashtra, India

Date of Web Publication10-Sep-2015

Correspondence Address:
Mythili Krishnan Rathinasabapathi
Department of Anatomy, Armed Forces Medical College, Pune - 411 040, Maharashtra
India
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Source of Support: Nil., Conflict of Interest: None declared.


DOI: 10.4103/0975-2870.164952

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  Abstract 

A case of the bifid rib was found during routine bone study. The distal part of the osseous rib bifurcated into two divisions with an angle of 60°. Both divisions had their own costal cartilage. Bifid rib is a congenital abnormality of the rib cage and usually asymptomatic, often discovered incidentally on chest X-ray. Effects of this neuroskeletal anomaly can include respiratory difficulties and neurological limitations.

Keywords: Bifurcated rib, chest wall anomaly, intrathoracic rib


How to cite this article:
Rathinasabapathi MK, Perumallapalli HK. Bifid rib: A rare anomaly. Med J DY Patil Univ 2015;8:670-1

How to cite this URL:
Rathinasabapathi MK, Perumallapalli HK. Bifid rib: A rare anomaly. Med J DY Patil Univ [serial online] 2015 [cited 2018 Nov 20];8:670-1. Available from: http://www.mjdrdypu.org/text.asp?2015/8/5/670/164952


  Introduction Top


A bifid rib (also bifurcated rib) is a congenital neuroskeletal abnormality of the anterior chest wall, which occurs in about 1.2% of humans.[1] The sternal end of the rib is cleaved into two. It is usually unilateral.

The overall prevalence of the bifid rib is estimated at 0.15-3.4% (mean 2%), and it accounts for up to 20% of all congenital rib anomalies. Rib anomalies are noted in 0.31% of routine chest radiographs.[2]

Most commonly it occurs in 4th rib. Asymptomatic and often discovered incidentally by chest X-ray.[3] A bicipital rib is different from the bifid rib and is seen in relation to the first thoracic rib. It appears to be the result of the fusion of two ribs, either of a cervical and first thoracic or of the first two thoracic ribs.


  Observation Top


During routine study of bones in Department of Anatomy, we found a left rib with bifurcation at the anterior end of the bone as shown in [Figure 1].
Figure 1: Lateral view of the left rib with pointer at the bifurcation

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Rib shows head with articular facets, tubercles, angle, and costal groove as of a typical rib as shown in [Figure 2].
Figure 2: Medial view of the left bifurcated rib with features of a typical rib

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  Discussion Top


A rib normally develops from the costal process of the developing thoracic vertebrae. Embryologically, development of the bifid rib is uncertain and probably results from incomplete fusion of cephalic and caudal segments of sclerotome during embryogenesis, occurring around the 4th-6th week of fetal life. During the mesenchymal and chondrogenic state of development, faulty fusion or anomalous chondrification may give rise to unusual fusion deformities of the ribs (bifid ribs), has been suggested as a possible cause.[4]

Ribs originate from the mesoderm. Bifid ribs may, therefore, be associated with other mesodermal abnormalities. Look specifically for malformations in other organs of mesodermal origin that is heart and kidneys.[2]

These anomalies are generally more common in females than in males, occur more frequently on the right side and they are usually asymptomatic. Type II intrathoracic rib is a so-called bifid intrathoracic rib.[5]

The distal parts of the osseous rib bifurcated with an angle of 60° and both of the divisions had their own costal cartilage. The costal cartilage fused again to form the trunk that was connected to the sternum. The space between the two divisions was filled with presumably normal intercostal muscles. Blood supply was maintained by a small branch from the internal thoracic artery to the upper divisions. However, the intercostal nerves did not branch toward the upper branch, but only ran along the lower margins of the lower divisions of the bifid ribs.[6]

Clinical associations

Gorlin-Goltz (basal cell nevus) syndrome (65-70% of patients), Job's syndrome,[7] Kindler syndrome, malignancy in childhood (esp neuroblastoma). Very rarely a bifid rib may occur as part of Gorlin-Goltz syndrome or Jobs syndrome or Kindler syndrome.


  Conclusion Top


The anomalies of the bones are less common to find. There is little information in the literature about the clinical significance of bifid ribs. Rib anomalies can occur in isolation or as part of vertebral malformations.

Knowledge of bifid ribs is necessary for the differential diagnosis with other diseases, such as tumors of the chest wall or costal fracture, because the various types of the bifid rib are present with diverse appearances on normal chest X-rays.[8]

The presence of an additional rib and intercostal space can mislead in rib and intercostal space counting during the postmortem examination and may lead to incorrect interpretation especially, while describing the thoracic injuries.

 
  References Top

1.
Kumar N, Guru A, Patil J, Ravindra S, Badagabettu SN. Additional circular intercostal space created by bifurcation of the left 3rd rib and its costal cartilage: A case report. J Med Case Rep 2013;7:6.  Back to cited text no. 1
    
2.
Scott CI. Pectoral girdle, spine, ribs and pelvic girdle. Hum Malformations Relat Anom 1993;2:670-1.  Back to cited text no. 2
    
3.
Etter LE. Osseous abnormalities of the thoracic cage seen in forty thousand consecutive chest photoroentgenograms. Am J Roentgenol 1944;51:359-63.  Back to cited text no. 3
    
4.
Bottosso N, Ghaye B. Bifid intrathoracic rib. JBR-BTR 2008;91:86-7.  Back to cited text no. 4
    
5.
Kamano H, Ishihama T, Ishihama H, Kubota Y, Tanaka T, Satoh K. Bifid intrathoracic rib: A case report and classification of intrathoracic ribs. Intern Med 2006;45:627-30.  Back to cited text no. 5
    
6.
Osawa T, Sasaki T, Matsumoto Y, Tsukamoto A, Onodera M, Nara E, et al. Bifid ribs observed in the third and the fourth ribs. Kaibogaku Zasshi 1998;73:633-5.  Back to cited text no. 6
    
7.
Freeman AF, Holland SM. The hyper-IgE syndromes. Immunol Allergy Clin North Am 2008;28:277-91, viii.  Back to cited text no. 7
    
8.
De Carvalho FH, Lopes GP. Intrathoracic rib: A case report. Radiol Bras 2012;45:121-2.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]



 

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  In this article
Abstract
Introduction
Observation
Discussion
Conclusion
Introduction
Observation
Discussion
Conclusion
References
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