Cervical rib

Case contributed by Dr Ahmed Mamoun Mohamed Ali

Presentation

Right supraclavicular hard mass, ultrasound revealed a long curved bony structure attached to the last cervical vertebra medially. On further questioning a history of chronic right upper limb pain was elicited. A C-spine MRI was unremarkable. Chest and neck x-rays were recommended to confirm the diagnosis and Doppler ultrasound on both subclavian artery and vein.

Patient Data

Age: 40 years
Gender: Female
X-ray

Right cervical rib arising from the seventh cervical vertebra which can cause thoracic outlet syndrome.

Case Discussion

  • Most cases of cervical rib are asymptomatic, discovered incidentally during routine chest x-ray interpretation.
  • They occur in ~0.5% of population, but only 10% of patients with a cervical rib will be symptomatic.
  • Symptoms occur due to compression of either the brachial plexus (~95% of cases) causing pain and numbness of the upper limb, subclavian vessels causing upper limb swelling, pain, deep vein thrombosis (DVT) and ischaemia or both neural and vascular elements.
  • Evaluation of thoracic outlet syndrome is done by Doppler ultrasound, contrast enhanced CT and MRI.
  • Treatment is surgical in most cases.

  

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Case information

rID: 56739
Case created: 19th Nov 2017
Last edited: 25th Nov 2017
Inclusion in quiz mode: Included
Institution: Aswan University

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