Bifid ribs: a comprehensive review
Bifid or bifurcated ribs are a rare anatomical anomaly that accounts for approximately 28% of known rib abnormalities. Bifurcation always occurs at the sternal end of the rib and its two extremities are joined to a bifid costal cartilage. The presence of bifid rib is frequently accompanied by other anomalies, although this does not necessarily imply that it cannot occur as an isolated anomaly. The clinical significance of the latter has not been established. There have not been many studiesdone to investigate bifid rib closely aside from individual case reports, presumably due to the condition’s extremely low incidence. However the detection of bifid ribs, though mostly incidental, has been proven advantageous for an early and wellrounded diagnosis It has also revealed significant preventive benefits especially in the pediatric patient population. This review is written to provide a comprehensive summary of what is known about bifid ribs and incorporate substantial findings from clinical cases that have been reported in past literature.
___
- 1. Wattanasirichaigoon D, Prasad C, Schneider G, Evans JA, Korf BR.
Rib defects in patterns of multiple malformations: a retrospective
review and phenotypic analysis of 47 cases. Am J Med Gen 2003;
122A:63–9.
- 2. Silverman FN, Kuhn JP, editors. Caffey’s pediatric x-ray diagnosis: an
integrated/imaging approach. 9th ed. St. Louis (MO): Mosby; 1993.
- 3. Rathinasabapathi MK, Perumallapalli HK. Bifid rib: a rare anomaly.
Medical Journal of Dr. D.Y. Patil University 2015;8:670–1.
- 4. Song WC, Kim SH, Park DK, Koh KS. Bifid rib: anatomical considerations
in three cases. Yonsei Med J 2009;50:300–3.
- 5. Etter LE. Osseous abnormalities in the thoracic cage seen in forty
thousand consecutive chest photoroentgenograms. Am J Roentgenol
Radium Ther 1944;51:359–63.
- 6. Patil VA, Lal V, Shaikh TP, Narayan P, Deolekar S. A rare case of
bilateral bifid ribs: a case report. International Journal of Research in
Medical Sciences 2014;2:1783–4.
- 7. Osawa T, Sasaki T, Matsumoto Y, Tsukamoto A, Onodera M, Nara
E, Chen J-K, Fujimura A, Nozaka Y. Bifid ribs observed in the third
and the fourth ribs. Kaibogaku Zasshi 1998;73:633–5.
- 8. Oostra RJ, Maas M. Bifid ribs and unusual vertebral anomalies diagnosed
in an anatomical specimen. Am J Med Genet A 2006;140:
2135–8.
- 9. Spörle R, Schughart K. Paradox segmentation along inter- and intrasomitic
borderlines is followed by dysmorphology of the axial skeleton
in the open brain (opb) mouse mutant. Dev Genet 1998;22:359–
73.
- 10. Schumacher R, Mai A, Gutjahr P. Association of rib anomalies and
malignancy in childhood. Eur J Pediatr 1992;151:432–4.
- 11. Gorlin RJ, Goltz RW. Multiple nevoid basal-cell epithelioma, jaw
cysts, and bifid rib: a syndrome. N Engl J Med 1960;262:908–12.
- 12. Koutnik AW, Kolodny SC, Hooker SP, Roche WC. Multiple nevoid
basal cell epithelioma, cysts of the jaw, and bifid rib syndrome: report
of a case. J Oral Surg 1975;33:686–9.
- 13. Suemori H, Takahashi N, Noguchi S. Hoxc-9 mutant mice show
anterior transformation of the vertebrae and malformation of the
sternum and ribs. Mech Dev 1995;51:265–73.
- 14. Zhang W, Behringer RR, Olsen EN. Inactivation of the myogenic
bHLH gene MRF4 results in up-regulation of myogenin and rib
anomalies. Genes Dev 1995;9:1388–99.
- 15. Martin EJ. Incidence of bifidity and related rib abnormalities in
Samoans. Am J Phys Anthropol 1960;18:179–87.
- 16. Kimonis VE, Mehta SG, DiGiovanna JJ, Bale SJ, Pastakia B.
Radiological features in 82 patients with nevoid basal cell carcinoma
(NBCC or Gorlin) syndrome. Genet Med 2004;6:495–502.
- 17. Stickley CD, Tamura K, Labrash SJ, Lozanoff S. Bifurcation of the
fourth rib as a possible indicator of Gorlin’s syndrome in an 85-yearold
female cadaver. International Journal of Anatomical Variations
2013;6:86–9.
- 18. Yunis JJ, Gorlin RJ. Chromosomal study in patients with cysts of the
jaw, multiple nevoid basal cell carcinomata and bifid rib syndrome.
Chromosoma 1963;14:146–53.
- 19. Rist E, Gally L, Trocme C. L’ossification des cartilages costauxdansl’especehumaine.
Presse Medicale 1928;36:641–4.
- 20. Glass BJ, Norton KI, Mitre SA, Kang E. Pediatric ribs: a spectrum
of abnormalities. Radiographics 2002;22:87–104.
21. Bottosso N, Ghaye B. Bifid intrathoracic rib. JBR-BTR 2008;91:86–
7.
- 22. Kamano H, Ishihama T, Ishihama H, Kubota Y, Tanaka T, Satoh K.
Bifid intrathoracic rib: a case report and classification of intrathoracic
ribs. Intern Med 2006;45:627–30.
- 23. Kupeli E, Ulubay G. Bony bridge of a bifid rib. Clev Clin J Med
2010;77:232–3.
- 24. Scheepers S, Andronikou S. Beware the bifid rib. South African
Journal of Radiology 2010;14:104.
- 25. Martinez-Frias ML, Frias JL, Opitz JM. Errors of morphogenesis
and developmental field theory. Am J Med Genet 1998;76:291–6.
- 26. Meerkotter VA, Shear M. Multiple primordial cysts associated with
bifid rib and ocular defects. Oral Surg Oral Med Oral Pathol 1964;
18:498–503.
- 27. Binkley GW, Johnson HH Jr. Epithelioma adenoids cysticum: basal
cell nevi. agenesis of corpus callosum and dental cysts. AMA Arch
Derm Syphilol 1951;63:73–84.
- 28. Gross PP. Epithelioma adenoides cysticum with follicular cysts of
maxilla and mandible. J Oral Surg (Chic) 1953;11:160–5.
- 29. Schamberg IL. Basal cell nevi. Arch Dermatol 1960;81:269.
30. Cagli K, Ozcakar L, Beyazit M, Sirmali M. Thoracic outlet syndrome
in an adolescent with bilateral bifid ribs. Clin Anat 2006;19:
558–60.
- 31. Guttentag AR, Salwen JK. Keep your eyes on the ribs: the spectrum
of normal variants and diseases that involve the ribs. Radiographics
1999;19:1125–42.
- 32. Bloomberg MW. Bifurcate ribs - an unusual cause of deformity of
the chest. Can Med Assoc J 1926;16:807–8.
- 33. Batra D, Lawner BJ. Bifid fifth rib in a 9-year-old girl with chest
pain. J Am Osteopath Assoc 2006;106:359–60.