Cervical rib | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Cervical rib

Focused radiograph of the upper chest shows a cervical rib (arrow) leading to a bifid configuration of the first rib. Cervical ribs arise from the lower cervical vertebral bodies. The cervical vertebral bodies can be differentiated from the thoracic vertebral bodies by the direction of the transverse process. The transverse process of the thoracic vertebral body points upward while the transverse process of the cervical vertebral body points downward.

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Image description Coronal MR angiogram (image 1) of the upper chest and coronal CT (image 2) show thrombus (arrow) within the left subclavian vein.

Teaching point Thoracic outlet syndrome encompasses venous, arterial, and neurogenic forms caused by compression of the neurovascular bundle at the thoracic outlet. Predisposing factors include congenital anomalies such as a cervical rib or elongated transverse process, acquired narrowing from clavicular or first-rib abnormalities, and dynamic compression related to posture or repetitive overhead activity. In the venous form, chronic compression of the subclavian vein leads to endothelial injury and stasis, predisposing to thrombosis.

AP Radiograph of the cervical spine in an adolescent shows bilateral cervical ribs at C7. Cervical ribs are an uncommon anatomic variant occurring in 1:200 people. While cervical ribs are usually asymptomatic, they can cause thoracic outlet syndrome. #NeuroWednesday

3D reformat CT (image 1), and coronal maximum intensity projection (image 2) of the cervical spine highlight the findings of atlantooccipital dissociation with posterior displacement of the C1 vertebral body (arrow) and increased space between the odontoid process and the occiput. In a neonate, nonaccidental trauma should be considered. A skeletal survey should be performed. In this patient, multiple posterior rib fractures (arrowheads image 3) and a classic metaphyseal lesion (dashed arrow) of the distal humerus (image 4) were also present.

Sagittal (image 1) and axial (image 2) CT of the thoracic spine show an abnormal appearance of the occiput, thoracic vertebral bodies, and visible ribs. The skull base is thickened and sclerotic with a ground-glass matrix. Vertebral bodies are enlarged with a ground-glass matrix. Pathologic fractures with vertebral plana are present at multiple levels. The findings are typical of polyostotic fibrous dysplasia. Other entities that can cause multiple lucent lesions in the skull include metastatic neuroblastoma or Langerhans' cell histiocytosis. Lesions that can cause expansion of the skull include metastatic neuroblastoma, beta thalassemia, and sickle cell disease.