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.
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Right cervical rib arising from the seventh cervical vertebra which can cause thoracic outlet syndrome.
- 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.
- 1. Kurihara Y, Yakushiji YK, Matsumoto J et-al. The ribs: anatomic and radiologic considerations. Radiographics. 19 (1): 105-19. Radiographics (full text) - Pubmed citation
- 2. Remy-Jardin M, Remy J, Masson P et-al. Helical CT angiography of thoracic outlet syndrome: functional anatomy. AJR Am J Roentgenol. 2000;174 (6): 1667-74. doi:10.2214/ajr.174.6.1741667 - Pubmed citation
- 3. Aralasmak A, Karaali K, Cevikol C et-al. MR imaging findings in brachial plexopathy with thoracic outlet syndrome. AJNR Am J Neuroradiol. 2010;31 (3): 410-7. doi:10.3174/ajnr.A1700 - Pubmed citation
- 4. . Demondion X, Herbinet P, Van sint jan S et-al. Imaging assessment of thoracic outlet syndrome. Radiographics. 26 (6): 1735-50. doi:10.1148/rg.266055079 - Pubmed citation
- 5. Kaufman JA, Lee MJ. Vascular and interventional radiology, the requisites. Mosby Inc. (2004) ISBN-10: 0815143699.