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Case of the Month

by Dr Noreen Norfaraheen Lee Abdullah MD (UKM), MMed Radiology (UKM), AM(Mal)

Answer to Case Of the Month 
Left Cervical Rib

Discussion of Findings
The lung volumes are adequate and clear. No focal lung lesion seen. Heart size and the mediastinal contours are normal. There is a bony projection seen arising from the C7 vertebra on the left side, which is in keeping with a left cervical rib.
Cervical Rib
In normal circumstances, there are 12 pairs of ribs. The ribs are attached to the thoracic vertebra. In some instances, there may more than 12 ribs or even less than that.

Cervical rib is defined as a supernumerary or extra rib, which arises from the seventh cervical vertebra. It is usually located above the normal first rib. A cervical rib is present in about 1 in 200 (0.5%) of people. Usually the cervical ribs occur bilaterally but in this case only the left side is present. Cervical ribs may cause nerve and artery problems. This is due to compression onto the neurovascular bundle at the neck base. The rib narrows the interval between the scalenus muscles and pose a high barrier for the nerves and vessels to pass over. Sagging of shoulders or carrying heavy things accentuates compression.

Typical symptoms include numbness, pain and paraesthesia of the affected hand and inner forearm (dermatome levels C8 to T1). Raynaud’s phenomenon may be encountered and the worst scenario would be gangrene. The cervical rib may be palpable clinically although in the majority it is asymptomatic and is normally an incidental finding on a routine chest radiograph.
 
About the Author 
Dr Noreen, a Consultant Radiologist is currently with the Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
 
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Last Updated:
Tuesday, 01 January 2008