Fork Rib: A Rare Musculoskeletal Etiology of Chest Pain
Keywords:chest pain, musculoskeletal, fork-rib
AbstractChest pain is a common clinical presentation in daily practice. Musculoskeletal origin is a rare etiology of chest pain, compared to a cardiorespiratory problem and often underrecognized. Fork-rib or bifid-rib is a rare anomaly which uncommonly present with clinical symptoms since in most cases fork-rib incidentally found during cadaveric dissection. Here we report a 27 years old man presenting with chest pain and radiographic examination showing bifid rib of the fifth left rib, without any abnormalities from physical examination and electrocardiography. The patient treated with intravenous painkiller and anticonvulsants. Fork-rib should be considered as a differential diagnosis for chest pain of musculoskeletal origin especially in young adults or chest pain precede with minor trauma.Â
Ayloo A, Cvengros T, Marella S. Evaluation and Treatment of Musculoskeletal Chest Pain. Prim Care - Clin Off Pract. 2013;40(4):863â€“87. [PMID: 24209723, doi: 10.1016/j.pop.2013.08.007 ]
Andrea A, Tardieu G, Fisahn C, Iwanaga J, Oskouian RJ, Tubbs RS. Bifid ribs: a comprehensive review. Anatomy. 2017;10(3):221â€“7. [doi:10.2399/ana.16.034]
Kinâ€‘Sun W, Yenâ€‘Chun H, Shenâ€‘Hao L, Chihâ€‘Yung C. Focal chest wall protuberance due to forked ribs or cartilages: An analysis of 12 cases. Pediatr Respirol Crit Care Med. 2017; 1:22â€“4. [doi: 10.4103/prcm.prcm_13_16]
Kumar V, Veernnasetty VK, Raghavendra AY. Bifid rib and an additional intercostal space: A case report. OA Anatomy.2014;2(3):29.
Osawa T, Onodera M, Feng X, Matsumoto Y, Nara E, Fujimura A, et al. Two cases of bifid rib in the fourth and fifth rib. Dent J Iwate Med Univ. 2002; 27:98-103.[https://doi.org/10.20663/iwateshigakukaishi.27.2_98]
Stickley CD, Tamura K, Labrash SJ, Lozanoff S. Bifurcation of the fourth rib as a possible indicator of Gorlinâ€™s syndrome in an 85-year-old female cadaver. Int J Anat Var. 2013; 6:86â€“9.
Song WC, Kim SH, Park DK, Koh KS. Bifid rib: Anatomical considerations in three cases. Yonsei Med J. 2009;50(2):300â€“3. [doi: 10.3349/ymj.2009.50.2.300]
Kumar N, Guru A, Patil J, Ravindra S, Badagabettu SN. Additional circular intercostal space created by bifurcation of the left 3rd rib and its costal cartilage: a case report. J Med Case Rep. 2013;7(1):7â€“9.
Konkani N, Khokhariya A, Chaudhary S. Anatomical variation of human thoracic rib in dry bone. 2017;9(2):8â€“11.
Rathinasabapathi M, Perumallapalli H. Bifid rib: A rare anomaly. Med J Dr DY Patil Univ. 2016;8(5):670. [doi:10.4103/0975-2870.164952]
Mahajan PS, Hasan IA, Ahamad N, Al Moosawi NM. A Unique Case of Left Second Supernumerary and Left Third Bifid Intrathoracic Ribs with Block Vertebrae and Hypoplastic Left Lung. Case Rep Radiol. 2013; 2013:1â€“4. [https://doi.org/10.1155/2013/620120]
Meerkotter V, Shear M. Multiple primordial cysts associated with bifid rib and ocular defects. Oral Surg Oral Med Oral Pathol. 1964;(18):498â€“503.[https://doi.org/10.1016/0030-4220(64)90399-8]
Gorlin R, Goltz R. Multiple Nevoid Basal-Cell Epithelioma, Jaw Cysts and Bifid Rib. N Engl J Med. 1960;262(18):908â€“12. [PMID: 13851319, doi: 10.1056/NEJM196005052621803 ]