대한흉부영상의학회 Weekly Chest Cases

Case No : 300 Date 2003-07-26

Courtesy of Yang Soo Kim, M.D. / Yongsan Hospital, Chungang University Medical Collage, Seoul, Korea
Age/Sex 18 / M
Chief ComplaintIncidentally found rib abnormality. No trauma history

Figure 1

Diagnosis With Brief Discussion

Diagnosis: Anomalous articulation of the rib
Radiologic Findings: Radiolucent lines through the mid portion of right 1st, 2nd and left 1st ribs with dense wavy sclerotic border and calluslike change which simulate healing fracture.
Brief Review: Anomalous articulation of the rib is almost always asymptomatic and found parenthetically on routine plain chest films. In 1944 Etter reviewed 40,000 consecutive roentgenograms and found 31 cases(1 in 1290, 0.078%) of anomalous first ribs that simulated an isolated fracture(1). In 1945 Bowie and Jacobson reviewed 62,782 roentgenographic chest examinations and found 17 cases(1 in 3692, 0.027%) of anomalous articulation of the first rib(2). Anomalous articulation forms a calluslike change and pseudoarthrosis, which is often mistaken for an old, unhealed fracture. Pseudoarthrosis not caused by fracture is believed to develop from one center of ossification that progressed into two centers. A permanent gap between the ribs may remain. This may sometimes be palpated as hard, fixed mass in supraclavicular fossa and thus mistaken for supraclavicular neoplasia.(3).
References: 1. Etter LE. Osseous abnormalities of the thoracic cage seen in forty-thousand consecutive chest photoroentgenograms. AJR 1944;51:359-63.

2. Bowie ER, Jacobson HG. Anomalous development of the first rib simulating isolated fracture. AJR 1945;53:161-5.

3. Zrada SE, Finkelstein JM. Anomalous articulation of the first rib mimicking supraclavicular neoplasia. Otolaryngol Head Neck Surg. 1997;116(3):389-91.

4. Keats TE. Atlas of normal roentgen variants that simulate disease. 5th ed. St. Louis: Mosby-Year Book, 1992:364.

5. Adam R. Guttentag, Julia K. Salwen. Keep your eyes on the ribs : The spectrum of normal variants and diseases that involve the ribs. Radiographics 1999;19:1125-42.
Keywords: Rib, Congenital,

No. of Applicants : 23

▶ Correct Answer : 11/23, 47.8%

- Annecy Hospital, France Gilles Genin
- Bharat Scans, India P Xavier Rajesh
- Chonnam National University Hospital Suk-Hee Heo
- CHU Nancy-Brabois, France Denis Regent
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- Incheon Sarang Hospital, Korea Jung Hee Kim
- Korea University Anam Hospital, Korea Bo Kyung Je
- MD anderson cancer center, TX, USA Jeong-Geun Yi
- Seoul National University Hospital, Korea Jung-Gi Im
- Shinmasan Hospital, Korea Kyung Hwa Jung
- Social Security Hospital, Ankara, Turkey Meric Tuzun

▶ Semi-Correct Answer : 3/23, 13.0%

- CIM Saint Dizier, France JC Leclerc
- Tokyo Kouseinenkin Hospital , Japan Noriatsu Ichiba
- Upasana Hospital, Kollam, India Joy A Thomas

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 300 Date 2003-07-26

Discussion

No. of Applicants : 23