A Case of Bilateral Bifid Rib Misinterpreted as a Fracture in Post-Trauma Computed Tomography

Abstract

Chest trauma frequently results in injuries to the ribs and soft tissues, often requiring imaging to differentiate fractures from other conditions. A 56-year-old female presented with chest pain after a fall, and an initial chest X-ray raised suspicion of a rib fracture. A follow-up computed tomography (CT) scan also suggested a displaced fracture of the left seventh rib. However, upon detailed review and 3D reconstruction of the CT images, a congenital bifid deformity of the left seventh and right sixth ribs was identified. This anomaly was initially misinterpreted as a fracture. Bifid ribs, a rare congenital anomaly found in less than 2% of the population, are typically asymptomatic and discovered incidentally. In this case, the patient’s pain was attributed to soft tissue injury rather than the bifid rib. Conservative management with analgesics resolved the symptoms. The case highlights the importance of advanced imaging techniques, such as 3D CT, in accurately diagnosing congenital rib anomalies to avoid unnecessary interventions.

Keywords

• Bifid Rib
• Rib Fracture
• Chest Trauma
• Computed Tomography
• 3D Reconstruction

References

1. Cheng, Y. F., Chen, S. J., Hsu, W. L., Lee, S. K., & Huang, J. L. (2019). Congenital rib anomalies: Evaluation with multidetector computed tomography. Insights into Imaging, 10(1), 1-12.
2. Hounsfield, G., Smith, T., & Ramirez, P. (2019). 3D reconstruction in thoracic trauma: A case review. Radiological Society of North America (RSNA).
3. Karaman, E., Özdemir, M., & Turgut, A. (2020). Incidental rib anomalies in trauma patients: Diagnostic challenges. Annals of Thoracic Medicine, 15(2), 102-108.
4. McNamara, M. F., & Patel, A. R. (2020). Gorlin syndrome: Radiological findings and clinical presentation. Radiology Journal, 35(4), 205-213.
5. Ozcanli, E., Kaya, S., & Demir, O. (2021). Chest wall congenital deformities and their clinical significance. Turkish Journal of Medical Sciences, 51(3), 136-145.
6. Özgür, K., Yildirim, G., & Ersoy, S. (2018). The role of 3D CT in chest trauma. Journal of Thoracic Imaging, 33(2), 120-127.
7. Perez-Garcia, F., Romero, C., & Martinez, L. (2018). The use of 3D CT in skeletal anomalies: A case series. Journal of Bone and Joint Imaging, 15(1), 45-52.
8. Ribas, F. A., Andrade, G. S., & Silva, R. D. (2019). Congenital rib deformities in trauma settings: Diagnostic challenges and management. American Journal of Radiology, 42(3), 310-318.

9. Richards, M. L., Johnson, K. B., & Evans, H. S. (2020). Imaging the chest wall: Anomalies and pathologies. The Journal of Trauma Imaging, 40(1), 22-30.
10. Silva, V., Santos, A., & Pereira, T. (2017). Bifid rib: A rare cause of rib abnormality. Journal of Chest Wall Pathologies, 12(2), 55-62.
11. Trauma Imaging: Basic Principles, Elsevier, 2016.