Bifurcated hypoplastic 4th rib with supernumerary lumbar ribs

Case contributed by Muhammad Shoyab


Facial papilloma. Pre-surgical checkup for excision under general anesthesia.

Patient Data

Age: 2 years
Gender: Male

X-Ray Chest A/P View


Right 4th rib is bifurcated at its lateral angle, accompanied by absence of its anterior shaft.

Right 4th intercostal space is narrowed.

Lumbar rib (13th) is present on both sides.

Vertebral bodies are normal.

Echocardiography : Normal

Case Discussion

Reduction of right 4th intercostal space is due to partial absence of bony attachment site (i.e. rib) for the intercostal muscles. Consequently, there is localized restriction of lung expansion in this area, which may predispose to localized infection.

Bifurcated rib may also predispose to entrapment of intercostal neurovascular bundles, although not in this case.

Lumbar rib is mostly inconsequential.

Although bifurcated rib is a component of Gorlin syndrome, this patient did not fulfill the diagnosis in terms of major and minor criteria.

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