T1 rib metastasis
Citation, DOI, disclosures and case data
At the time the case was submitted for publication Ian Bickle had no recorded disclosures.View Ian Bickle's current disclosures
Renal cell carcinoma and myeloma. Known myeloma. Increasing pain in right shoulder and cervical spine.
Loading Stack -
0 images remaining
Multilevel degenerative change in the cervical spine.
Absence of part of the right 1st rib from the costovertebral junction in keeping with destruction from an aggressive bone lesion.
The pathology is only evident on the AP view and is a site where we rarely identify pathology.
In addition, the absence of something is often harder to spot than the presence of something on plain radiographs.
Subsequent CT imaging confirmed a destroyed first rib - in this case from a renal cell carcinoma metastasis or a myelomatous deposit.
It makes a reasonable starter film in a fellowship viva for the powers of observation, providing a differential and how one might manage it clinically.