Case Description
A 10-month-old infant presented with a hard chest wall mass, palpable at the level of the left fourth rib, and was found to have a bifid left fourth rib on chest radiography (Fig. 1). This was later confirmed using 3-dimensional chest computed tomography reconstruction (Fig. 2), which also ruled out any other masses in the chest wall or in the pleural or pericardial spaces.
Fig. 1.
Chest radiograph showing a bifid left fourth rib.
Fig. 2.
Three-dimensional computed tomography reconstruction of the chest showing an isolated bifid left fourth rib.
Comment
Bifid rib is a rare congenital abnormality with an overall prevalence of 0.15% to 3.4% (mean, 2%). Several case reports and case series have described bifid rib in older children and adults who present with chest wall masses.1 However, in neonates and infants, sarcomas are the most common causes of asymptomatic chest wall masses; these include Ewing sarcoma, rhabdomyosarcoma, osteosarcoma, and chondrosarcoma.2 Therefore, any chest wall mass in an infant or child should be investigated using chest radiography followed by computed tomography.3 There are no prior reports in the literature of bifid rib presenting as a chest wall mass in a neonate or infant.
A single bifid rib is most commonly a normal incidental finding and does not require intervention. However, any neonate or infant presenting with a bifid fourth rib should be investigated for Gorlin syndrome. These patients may be asymptomatic during childhood but are predisposed to develop basal cell carcinoma and medulloblastoma.4 Although rare, an association between bifid ribs and intracranial hemorrhage in infants has been reported.5 Therefore, infants with bifid rib should be followed closely.
Funding Statement
Funding/Support: None
Footnotes
Conflict of Interest Disclosures: The authors report no conflicts of interest, and no funding support was received for this report.
References
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