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Chest OPD चेस्ट ओपीडी में आने वाले मरीजों के चेस्ट एक्स-रे में सुपरन्यूमेरी पसलियों की घटना और नैदानिक ​​महत्व


Chest OPD चेस्ट ओपीडी में आने वाले मरीजों के चेस्ट एक्स-रे में सुपरन्यूमेरी पसलियों की घटना और नैदानिक ​​महत्व

Incidence and Cinical Significance of Supernumerary Ribs in Chest X-rays of patients attending the Chest OPD

Arnav Agarwal, UG Student, KMC Manipal, Dr. Jolly Agarwal, Associate Professor, Dept. of Anatomy, GDMC, Dehradun,
Dr Abhinav Kumar, PG Resident, Dept. of Anatomy, GDMC, Dehradun, Dr. M.K. Pant, Prof. and Head, Dept. of Anatomy,
GDMC, Dehradun, Dr. Anurag Agrawal, Prof. and Head, Dept. of Pulmonary Medicine, GDMC, Dehradun

Introduction:
• A cervical rib is an additional rib which arises with the 7th cervical vertebra and is usually attached to the 1st rib, closed to the (Chest OPD) insertion of scalenus anterior.
• Cervical rib may be unilateral or bilateral.
• It is more common on right side.
• Cervical rib may have a free anterior end, be connected to the first rib by a fibrous band, or may articulate with the first rib.

Material & Methods: Chest OPD

• The present study was done in the Dept. of Anatomy and Dept. of Pulmonary Medicine,
• The sample consisted of 250 consecutive cases of all ages and both sexes presenting in Pulmonary Medicine OPD as well as indoor wards.
• This study was done over a two month period.
• Chest radiographs (P-A view) of these subjects were examined for presence of cervical rib.

Suspended: मिड-डे मील घोटाला: बच्चों की फर्जी हाजिरी से प्रधानाध्यापक की सस्पेंशन तक

Results

• A cervical rib was present in 3 cases – 2 bilateral and 1 unilateral on left side (incidence 1.2%).
• Nobody had any symptoms due to cervical rib. No other bony thoracic abnormalities was seen.

Clinical Importance Chest OPD

In the majority of subjects, it is an incidental finding on a chest radiograph advised for unrelated symptoms.
Presence of cervical rib should be borne in mind for correct diagnosis and therapeutic purposes.
Usually it is asymptomatic, but in less than 10% of subjects it may give rise to various neurological, vascular or local symptoms.

Cervical Rib Syndrome: Chest OPD

The brachial plexus and subclavian artery pass through a narrow triangle bounded by two scalenei and the 1st rib. When the base of this triangle is raised by presence of a cervical rib,brachial plexus and subclavian artery may be compressed and produce neurological & vascular symptoms respectively.

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Thoracic Outlet Syndrome
A cervical rib is one of the etiological factors in thoracic outlet syndrome. Other causes of that produce similar symptoms :
• Fibrous band passing from scalenus medius or scalenus anterior to its insertion
• Misaligned fracture of clavicle
• Hypertrophied subclavius muscle

Conclusion:

The incidence of cervical rib was found to be 1.2% and it may be found incidentally without causing any symptoms or may cause vascular, neurological or local symptoms.

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References: Chest OPD
1. Gayler BW, Donner MW. Radiographic changes of the ribs. Am J Med Sci 1967; 253; 586
2. Dick R. Arteriography in neurovascular compression at the thoracic outlet, with special reference to embolic pattern. Am J Roentgenol 1970; 110; 141
3. Scher LA, Vieth FJ, HaImovici H et al. staging of arterial complications of cervical rib: guidelines for surgical management. Surgery 1984; 95; 644.
4. Grimer RJ, Mulligan PJ, Thompson AG. Thoracic Outlet Obstruction following correction of scoliosis ia a patient with cervical rib. J Bone Joint Surg 1983; 65A; 1172.
5. Lagerquist LG, Tyler FH. Thoracic Outlet Obstruction with tetany of the hands. Am J Med 1975; 59; 281
6. Ruckley CV. Thoracic Outlet Syndrome. Br Med J 1983; 287; 447
7. Tsirikos AI, MaMaster MJ. Congenital anomalies of the ribs and chest wall associated with congenital deformities of the spine. J Bone Joint Surg Am 2005; 87; 2523- 36.
8. Albert B.etal Molecular biology of the cells, (5thedition) NewYork, 2008;1345-1347
9. Keith L.Moore etal Clinically Oriented Anatomy(6th edition)Philadelphia, 2010 Lippincott Williams and Wilkins Philadelphia USA
10. Anne M.R.Agur,Arthur F.Dalley Grant Atlas of Anatomy(12th edition) Philadelphia,2009 Lippincott Williams and Wilkins Philadelphia USA.


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