Cervical rib

Case contributed by Ahmed Mamoun Mohamed Ali
Diagnosis certain

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

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

x-ray

Right cervical rib arising from the seventh cervical vertebra.

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 ischemia 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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