International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 06 Issue 06, March, 2014

Pages: 84-86

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BIFID RIBS - A RARE CHEST WALL DEFORMITY:A CASE REPORT

Author: Murali Krishna S., Rajesh V., Udaya Kumar P., Kalpana T., Chandra Mohan M., Naveen Kumar B.

Category: Healthcare

Abstract:Aim: Aim of the present case is to report and describe a rare case of chest wall deformity in a 70 years old male cadaver. Case Report: Variations in the anterior chest wall are rare. Present case describes bifid ribs involving the right 3rd rib and 3rd costal cartilage, 5th rib and 5th costal cartilage which were observed during routine dissections for undergraduate medical students. When compared to the lower intercostal spaces, the upper intercostal spaces of the third and fifth bifid ribs were found to be narrow. Intercostal muscles were present in both the bifid spaces. They received their nerve supply and arterial supply from the 3rd and 5th intercostal nerves and arteries respectively. Conclusion: It is important to know about such anatomical variations, for clinicians during differential diagnosis with other diseases, such as a chest wall tumors or costal fracture and for counting the ribs.

Keywords: Bifid rib, intercostal space

Full Text:

INTRODUCTION

Twelve pairs of ribs develop from costal processes in thoracic region during the 9th week of intrauterine life. The elongated cartilaginous costal arches get ossified to form the ribs. True ribs articulate to the sternum via the costal cartilages by 45th day and false ribs do not articulate with the sternum. Secondary ossification centers appear at 15 years. [1] A bifid rib is a congenital abnormality found in the anterior chest wall, with the sternal end of the rib cleaved into two, enclosing an additional intercostal space. The over all prevalence of bifid rib is 0.15% to 3.4% of the population. It is commonly unilateral and may be asymptomatic. This anomaly may be found incidentally on chest radiography [2].

CASE REPORT

During routine cadaveric dissection of the thorax of a man aged about 70 years, in Department of Anatomy, Mamata Medical College, Khammam, we observed variations of bifid appearance involving the right 3rd rib and 3rd costal cartilage and right 5th rib and 5th costal cartilage enclosing an additional circular intercostal space. On careful observation of the specimen we found that intercostal muscles were present in both the additional intercostal spaces but the 3rd additional intercostal space was too small space for the muscles to be distinguished. They were supplied by collateral branches of 3rd and 5th intercostal nerves. Arterial supply was by 3rd and 5th intercostal arteries. The dimensions of upper intercostal spaces were narrower than the lower intercostal spaces. The morphological measurements revealed that the distance from the lateral border of sternum to the bifid point in the 3rd intercostal space is 3.8 cm and in 5th intercostal space is 3.2 cm. The additional intercostal space of the 3rd bifid rib measured 1 cm in vertical distance and 0.7 cm in transverse distance and of 5th bifid rib is 2.5cm in vertical distance and 3.7 cm in transverse distance. The upper intercostal space between the 2nd and 3rd rib was narrowed and it measured 0.5 cm. The lower intercostal space between the 3rd (unusual rib) and 4th rib was widened measuring 2 cm. The upper intercostal space between the 4th and 5th rib was narrowed and it measured 0.1cm and the lower intercostals space between 5th and 6th rib measured 1.6 cm (Table No. 1). 

DISCUSSION

Common congenital rib anomalies can be classified into numerical and structural. Numerical anomalies include supernumerary ribs like cervical, lumbar, pelvic or sacral and sometimes deficiency in total number of ribs. Structural abnormalities include short ribs, bifid ribs, fused or bridged ribs and pseudoarthrosis of first rib. [2, 3] Bifurcation of the rib and presence of additional intercostal spaces is a rare abnormality of thorax. Very few cases have been reported on such variations. Song et al., reported three cases of bifurcation of the right fourth rib [4]. Cristopher D Stickly et al., reported the presence of bifurcated 4th rib in one cadaver [5]. Development of intra thoracic rib is doubtful, however it may result from an incomplete fusion of cephalic and caudal segments of sclerotome during the development, occurring around the 4–6th week of foetal life [6]. The incidence of bifid ribs is more frequent in males than females. It is more common in the third and fourth ribs (degree of incidence - third > fourth > fifth > sixth > second) [5, 7]. Comparatively it is more prevalent on the right side of the chest than on the left side [8]. Some times bifid ribs can be present on both the sides. Presence of bifid rib may be associated with a syndrome called Basal cell nevus syndrome or Gorlin-Goltz syndrome. It is a hereditary multisystemic disorder that predominately affects the skeletal system, skin, eye and reproductive systems [9]. In the present case, bifid ribs were present in 3rd and 5th intercostal spaces on right side with narrowing of upper intercostal spaces.

CONCLUSION

This is the first case reported in cadavers where two bifid ribs are present on right side of the chest wall. It is necessary for the clinicians to know about this malformation because this may cause confusion during counting the ribs for some surgical procedures and diagnostic procedures. It is also necessary for the differential diagnosis with other diseases, such as costal fractures and chest wall tumours.

Competing interests

The authors declare that we have no competing interests

Ethical committee clearance

As the study included only human cadavers, ethical committee clearance was not taken into consideration. Authors will take the responsibility of any further allegations regarding ethical clearance that arise from the study.

 

References:

REFERENCES

1 Ronald b.j glass,MD,Karen,I,Norton et al, paediatric ribs: a spectrum of abnormalities, Radiographics January 2002 22:1 87-104.

2 Anita R, Archana R, Jyoti C, Punita M. Synostosis of First and Second Rib – Case Report. Jornal of Anatomical Society of India. 2009; 58(2): 189- 191. 

3 Deepak S, Dakshayani KR. An unusual Case of a Bicipital Rib – A Report. Anatomica Karnataka. 2011; 5(1): 50-52.

4 Song WC, Kim SH, Park DK, Koh KS. Bifid rib: anatomical considerations in three cases. Yonsei Med J. 2009; 50: 300–303.

5 Cristopher D Stickly, Kaori Tamuri, et al., bifurcation of fourth rib as possible indicator of Gorlin Syndrome in a 85 yr old female cadaver. International Journal of Anatomical variation (2013) 6 : 86 – 89.

6 Satheesha Nayak.B. A case of bifid rib and additional intercostals space. International Journal of Anatomical Variations .2012 ;5:128–129.

7 Schumacher R, Mai A, Gutjahr P. Association of rib anomalies and malignancy in childhood. Eur J Pediatr. 1992; 151: 432–434.

8 Osawa T, Onodera M, Feng XY, Sasaki N, Nagato S, Matsumoto Y, et al., Two cases of bifid rib observed in the fourth and the fifth rib. Dental Journal of Iwate Medical University. 2002; 27: 98–103.

9 Rai S, Gauba K. Jaw cyst-Basal cell nevusBifid rib syndrome: A case report. J Indian Soc Pedod Prevent Dent - September 2007, 25:137-139

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Awards, Research and Publication incentive Schemes by IJCRR

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One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

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This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

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‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


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A Study by Monica K. entitled "Risk Predictors for Lymphoma Development in Sjogren Syndrome - A Systematic Review" is awarded Best Article for Vol 14 issue 13
A Study by Mokhtar M Sh et al. entitled "Prevalence of Hospital Mortality of Critically Ill Elderly Patients" is awarded Best Article for Vol 14 issue 12
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A Study by Vinita S & Ayushi S entitled "Role of Colour Doppler and Transvaginal Sonography for diagnosis of endometrial pathology in women presenting with Abnormal Uterine Bleeding" is awarded Best Article for Vol 14 issue 08
A Study by Prabhu A et al. entitled "Awareness of Common Eye Conditions among the ASHA (Accredited Social Health Activist) Workers in the Rural Communities of Udupi District- A Pilot Study" is awarded Best Article for Vol 14 issue 07
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A Study by Shanthan KR et al. entitled "Comparison of Ultrasound Guided Versus Nerve Stimulator Guided Technique of Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries" is awarded Best Article for Vol 14 issue 01
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A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10
A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
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A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
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A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
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A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
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A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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