Cardiovascular Radiology


Case 5:
A 24-year-old female presents with pain along the left arm and wasting of muscles of the hand. Following an x-ray, an MRI is performed. Scans shown here are T1 and T2 weighted axial images of relevant area. 
What is the diagnosis?

Click here for Bigger Picture

Click here for Bigger Picture

Fig 1

Fig 2


__________SCROLL FOR ANSWER__________
 

 

 

 

 

 

 

Imaging Findings reveal a cervical rib on the left side with evidence of brachial plexus compression. Thickening of the cords and trunk of the brachial plexus is noted on the left.

Diagnosis: Cervical Rib

Discussion
Cervical rib found in course of routine investigations rarely gives rise to symptoms, while when they are looked for in a symptomatic patient, they are rarely found!

Epidemiology :
Occurs in about 0.5% people. It is slightly more common on the right side, and is commoner in females. It may be associated with other spinal anomalies.

Pathology :
4 pathological types seen :

Complete rib - articulates anteriorly with the manubrium or the 1st rib.
Incomplete rib - has broad end which expands into a knob like mass.

Incomplete rib with tapering end with fibrous band attached to the manubrium / 1st rib.
Complete fibrous band.

The fibrous band types give more pressure symptoms.

Vascular effects -
Higher arching of Subclavian artery, post - stenotic dilatation, slowing of blood flow (thrombosis), gangrene (Raynaud's phenomenon)

Neural effects -
include higher arching of T1 segment of the brachial plexus, pain & parasthesiae in ilnar area of arm, forearm and hand

Treatment :
If bony rib found - extra-periosteal resection
If fibrous band - excision and/ or division of scalenus antecus.
If no fibrous band or rib - division of scalenus, and/or excision of 1st rib.
Cervical sympathectomy may be done.

Contribution
Dr. Ashok Raghavan, Manipal Hospital, Bangalore