Cervical rib

Clinical History

Vague pain with a sensation of pins and needles along the left arm.

Imaging Findings

The patient presented with vague pain and a sensation of pins and needles along the left hand. Chest radiographs and a cervical spine series were performed. On the chest and cervical radiographs, an osseous structure was seen arising from the transverse process of the seventh cervical vertebra. The transvese process of the same vertebra on the right side was elongated. The diagnosis was of a cervical rib on the left side.

Discussion

A cervical rib is a common anomaly and arises from the transverse process of the seventh cervical vertebra (or rarely the sixth and very rarely the fifth). The rib reflects hyperplasia of the transverse process secondary centre of ossification. It is more common in females, occurring in 11% of the general population, and is slightly more common on the right side. It may be associated with spinal anomalies. Occasionally it is just a fibrous band or a complete rib with articulation with the manubrium or the first rib. The transverse processes of the cervical vertebrae slope downward from the neural arch, whereas they slope upwards in the thoracic region. This anatomical difference helps to differentiate between a cervical rib and a rudimentary first rib.

Cervical ribs occur either unilaterally or bilaterally. They vary greatly in size and shape, and the clinical symptoms have very little relationship to the size and shape. Very small cervical ribs with a fibrous attachment to the first rib can cause more symptoms than large ones. A fibrous band of varying thickness and width is anatomically bound to the cervical rib in a plane parallel to the scalenus muscles. Compression of the adjacent neurovascular bundle can cause symptoms. Occasionally, a large transverse process can mimic a rib and the associated symptoms.

Plain films are usually diagnostic, however MRI can demonstrate the fibrous attachment better.

Various surgical methods have been described to alleviate the symptoms.

Differential Diagnosis List

Final Diagnosis

Cervical rib

URL:	https://www.eurorad.org/case/1825
DOI:	10.1594/EURORAD/CASE.1825
ISSN:	1563-4086