Presentation
Cough and fever for 7 days. Covid suspect. Smoker, asthmatic.
Patient Data
Bifurcation of right 1st rib at level of subclavian groove, followed by synostosis & sclerosis at anterior end, producing "hole-type" configuration.
Cervical rib on left side, forming pseudoarthrosis with left 1st rib.
Rudimentary cervical rib on right side.
Ground-glass haziness interspersed with thin linear opacities over lower zone of right lung field and middle zone of left lung field, involving peripheral region.
Case Discussion
Reunion of the two divisions of a bifid rib has been called "hole"-type by some authors 1.
The 1st rib is a very unusual location for bifid ribs, and while incomplete hole-type rib bifurcations have been reported earlier 1, complete hole-type bifurcation and that of the 1st rib may not have been reported at all. As such, this case is among the very unique.
Bifurcation of 1st rib on one side, accompanied by true cervical rib forming pseudoarticulation with 1st rib on the opposite side may predispose this patient to entrapment of neurovascular structures, and can lead to thoracic outlet syndrome. However, presently these are incidental findings discovered when the patient is presenting with cold and fever.
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