Case contribution: Dr Radhiana Hassan
Clinical:
- An 11 years old boy
- Admitted with clinical diagnosis of acute appendicitis
- Chest radiograph performed as pre operative assessment.
Radiographic findings:
- No focal lung lesion or consolidation.
- The mediastinal contour is preserved.
- The heart is not enlarged. Both costophrenic angles are sharp.
- The anterior aspect of right 4th rib appears bifid.
- The rest of the visualised bones and soft tissue are unremarkable. Impression: Incidental finding of bifid of right 4th rib.
Diagnosis: Incidental finding of bifid right rib.
Discussion:
- A bifid rib is a rare congenital anomaly of the rib cage.
- It is also called forked or bifurcated rib.
- Bifid ribs are also called Luschka’s rib.
- It is usually unilateral. However bilateral bifid ribs can also occur.
- It is more common on the right than on the left side.
- It is more common in males than females.
- It usually involve the third and fourth ribs (incidence: third or fourth > fifth > sixth > second).
- Two types have been identified:
- long and slender bifid spaces (fork type)
- rounded bifid spaces (hole type)
- Bifid ribs are usually asymptomatic and are often discovered incidentally
- Association:
- Gorlin syndrome (nevoid basal carcinoma)
- Truncus arteriosus
- Tetralogy of Fallot
