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PubMedDate not supplied

CT diagnosis of rib anomalies, tumors, and infection in children.

The computed tomography (CT) findings of 3 patients with Ewing's sarcoma and 10 patients with a variety of benign rib lesions including osteomyelitis, hemangiomatosis, eosinophilic granuloma, aneurysmal bone cyst, neurofibromatosis, enchondroma, and Jarcho-Levin syndrome are presented. CT is of great value in demonstrating characteristic findings of several benign rib lesions. Also, CT accurately shows the destructive pattern of the rib lesion, the presence of pleural effusion, and the local spread of the soft tissue mass. When an aggressive rib lesion with pleural effusion is encountered in an infant or child, Ewing's sarcoma must be excluded unless this lesion has characteristic radiographic findings and a strong clinical history that suggest another diagnosis. The CT findings and differential diagnosis of rib lesions are discussed. Three-dimensional CT well demonstrated the appearance of congenital rib anomalies.

Adolescent↗
PubMed2005

The incidence of hepatic pseudolesions caused by focal rib compression as seen on multidetector row CT in patients of different hepatic function.

OBJECTIVE: To determine whether the incidence of pseudolesions of the liver caused by rib compression is correlated with liver function. MATERIALS AND METHODS: Multidetector row CT images of 150 consecutive cases were evaluated for the presence of pseudolesions caused by rib compression. Liver function was categorized into two groups mainly using the Child-Pugh classification: Group I-normal liver function and Grade A; Group II-Grades B and C. The number of focal deformities of the liver caused by rib compression was also counted. The incidence of pseudolesions based on number of patients or focal deformities of liver parenchyma by rib compression were compared between the two groups. RESULTS: There were 108 and 42 patients in Groups I and II, respectively. 169 and 41 focal deformities of the liver caused by rib compression were found in Groups I and II, respectively. Patient-based and deformity-based incidences of pseudolesions were 10.7% (16/150) and 7.6% (16/210), respectively. All pseudolesions were seen in patients of Group I. Both patient-based and deformity-based incidences of pseudolesions were significantly higher in Group I as compared with those in Group II. CONCLUSION: Pseudolesions of the liver caused by focal rib compression may be seen more frequently in patients with preserved liver function than in those with impaired function.

Adult↗
PubMed2006

Sexual dimorphism of human ribs.

The volume of the rib cage is about 10% smaller in females than in males having the same height although the reason for this is presently unclear. The cranio-caudal inclination of ribs is greater in females than males but the length of ribs has not previously been compared between the sexes. In 23 males and 23 females studied at necropsy, body length, the length of the upper and lower limbs and the length of the thoracic spine were all smaller in females but the ratios of upper and lower limb lengths to body length and of thoracic spine length to body length were not different. By contrast, the lengths of the third, sixth and ninth ribs were not significantly different between males and females and the ratios of rib length to body length were all significantly greater in females. We conclude that in females the ribs grow longer in relation to the axial skeleton than in males.

Adolescent↗
PubMed2004

Frequency of rib and sternum fractures associated with out-of-hospital cardiopulmonary resuscitation is underestimated by conventional chest X-ray.

OBJECTIVE: Fractured ribs and sternum are frequent complications of thoracic compression during CPR in adults. This study was conducted to determine whether findings of plain chest radiography (CXR) correlate with post-mortem findings in patients who underwent cardiopulmonary resuscitation (CPR) after out-of-hospital cardiac arrest. METHODS: CXR findings and autopsy results of CPR-related chest injuries comprising rib and sternum fractures were compared prospectively in 19 patients. RESULTS: Fractures were diagnosed in nine of 19 patients by means of radiology and in 18 of 19 patients by autopsy (rib fractures in 6/19 versus 17/19, P=0.002; sternum fractures in 5/19 versus in 9/19, P=0.227. The total number of isolated bone fractures detected by CXR was 18 (12 rib and six sternum fractures) and by autopsy 92 (83 rib and nine sternum fractures). The majority of rib fractures was located in the anterior part of the thoracic cage. Sternum fractures predominantly occurred in the lower third. Eight of 19 patients received either thrombolytic or antithrombotic treatment during CPR but no major bleeding complication associated with CPR was detected by autopsy. CONCLUSIONS: The findings of this study indicate that fractures associated with CPR are underreported in conventional radiographic investigations. No major bleeding complications related to CPR-associated fractures was detected.

Adult↗
PubMedDate not supplied

Do anterior interbody cages have a potential value in comparison to autogenous rib graft in the surgical management of Scheuermann's kyphosis?

BACKGROUND CONTEXT: Previous studies have analyzed the outcome following posterior correction and combined anterior-posterior correction for Scheuermann's kyphosis. Traditionally interbody fusion has been obtained using morselized rib graft. Recently the use of titanium anterior cages has been suggested for interbody use. There are no long-term studies comparing these two techniques. PURPOSE: To investigate the potential value of titanium anterior interbody cages compared with morselized rib graft for anterior interbody fusion in combination with posterior instrumentation, correction, and fusion for Scheuermann's kyphosis. STUDY DESIGN: Nonrandomized comparison of two surgical techniques in matched subjects. PATIENT SAMPLE: Fifteen patients with identical preoperative radiographic and physical variables (age, gender, height, weight, body mass index) were managed with combined anterior release, interbody fusion, posterior instrumentation, correction, and fusion. Group A (n=8) had morselized rib graft inserted into each intervertebral disc space. Group B (n=7) had titanium interbody cages packed with bone graft inserted at each level. The posterior instrumentation extended from T2 to L2 in both groups. OUTCOME MEASURES: Preoperative and postoperative curve morphometry was studied on plain radiographs by two independent observers. The indices studied included Cobb angle, Ferguson's angle, Voutsinas index, sagittal vertical axis (SVA), sacral inclination (SI), and lumbar lordosis (LL). Interbody fusion was assessed at final follow-up. Each patient was reviewed at 3, 6, 12, 24, 48, and 60 months after surgery with standing radiographs. METHODS: Both surgical groups were compared in terms of radiological parameters and complications. Wilcoxon-matched pairs test and Mann-Whitney test were used. RESULTS: The average follow-up for Group A was 70 months and for Group B 66 months. For the whole group, the preoperative median Cobb angle for thoracic kyphosis was 86 degrees , the median Ferguson angle was 50 degrees , Voutsinas index was 28.7, SVA -3.5 centimeters, lumbar lordosis was 66 degrees , and the median sacral inclination angle was 40 degrees . The median postoperative Cobb angle was 42 degrees , Ferguson angle 28.4 degrees , Voutsinas index 13, SVA -4.0 centimeters, and the median sacral inclination angle was 34 degrees . There were significant differences between preoperative and postoperative measurements for all variables (p<.01), indicating that good correction was achieved. At 4-year follow-up, fusion criteria were satisfied in 12 of 15 cases (80%). Three patients had distal junctional kyphosis. There was no significant difference obtained in the final Cobb angle, Ferguson angle, and Voutsinas index when Group A (rib graft) was compared with Group B (titanium cage) Both Group A and B patients retained the postoperative correction achieved with respect to all the radiographic parameters studied. CONCLUSION: We were unable to demonstrate any significant advantage for the use of anterior titanium interbody cages over the use of morselized rib graft in the surgical management of Scheuermann's kyphosis. Given the not inconsiderable cost and the need for posterior chevron osteotomies when interbody cages are used, we have now reverted to our previous practice of using morselized rib graft at each intervertebral level.

Adult↗
PubMed2004

Epidural analgesia improves outcome after multiple rib fractures.

BACKGROUND: Rib fractures are common and associated with significant pulmonary morbidity. We hypothesized that epidural analgesia would provide superior pain relief, and reduce the risk of subsequent pneumonia. METHODS: A prospective, randomized trial of epidural analgesia versus IV opioids for the management of chest wall pain after rib fractures was carried out. Entry criteria included patients older than 18 years with more than 3 rib fractures and no contraindications to epidural catheter placement. RESULTS: From March 2000 to December 2003, 408 patients were admitted with more than 3 rib fractures; 282 met exclusion criteria, 80 could not be consented, and 46 were enrolled (epidural n = 22, opioids n = 24). The groups were comparable for mean age, injury severity score, gender, chest Abbreviated Injury Scale, and mean number of rib fractures. The epidural group tended to have more flail segments (38% vs 21%, P = .20) and pulmonary contusions (59% vs 38%, P = .14), and required more chest tubes (95% vs 71%, P = .03) Despite the greater direct pulmonary injury in the epidural group, their rate of pneumonia was 18% versus 38% for the intravenous opioid group. When adjusted for direct pulmonary injury, there was a greater risk of pneumonia in the opioid group: OR, 6.0; 95% CI, 1.0-35; P = .05. When stratified for the presence of pulmonary contusion there was a 2.0-fold increase in the number of ventilator days for the opioid group: incident rate ratio, 2.0; 95% CI, 1.6-2.6; P < .001. CONCLUSIONS: The use of epidural analgesia is limited in the trauma population due to numerous exclusion criteria. However, when feasible, epidural analgesia is associated with a decrease in the rate of nosocomial pneumonia and a shorter duration of mechanical ventilation after rib fractures.

Adult↗
PubMed1999

Micrometastases in esophagogastric cancer: high detection rate in resected rib segments.

BACKGROUND & AIMS: Micrometastases within bone marrow indicate a poor prognosis. We prospectively examined micrometastases in patients undergoing resection of esophagogastric cancers for (1) prevalence in rib marrow; (2) comparative detection rates in rib and iliac crest marrow; (3) responsiveness to neoadjuvant therapy; and (4) viability and tumorigenicity. METHODS: In 50 consecutive patients, marrow was obtained before manipulation of the primary tumor. Micrometastatic cells were detected by staining contaminant cytokeratin-18-positive cells. Viability and tumorigenicity were determined by culture and xenograft. RESULTS: Micrometastases were detected in rib marrow from 88% of patients (44 of 50). When bilateral iliac crest marrow was also obtained, micrometastases were found in 15% (4 of 27) compared with 89% (24 of 27) for ribs (P < 0.001). Detection rates were independent of histological type or nodal status and were similar in patients with and without neoadjuvant therapy. Metastatic cells were cultured from rib marrow of 5 of 7 patients and were tumorigenic in nude mice. CONCLUSIONS: Most patients undergoing resection of esophagogastric malignancies have micrometastases in rib marrow. Detection rates based on iliac crest marrow are underestimates. Hematogenous spread of metastatic cells is independent of histological type or nodal status. The metastatic cells are viable, tumorigenic, and resistant to neoadjuvant therapy.

Adenocarcinoma↗
PubMed1999

Posttraumatic fibro-osseous lesion of rib.

Eleven cases are described of an unusual, benign, fibro-osseous lesion of rib previously reported under a variety of designations, including painless fibro-osseous lesion resembling osteoid osteoma, symmetrical fibro-osseous dysplasia, focal Erdheim-Chester disease, and fibro-osseous pseudotumor. All patients were adults, most of whom were asymptomatic, the lesion discovered by bone scans done to rule out metastatic disease. A single rib was involved in eight patients and multiple ribs in three. A roentgenographic abnormality was apparent in only five patients. Histologically, all lesions showed a bland fibrous stroma in which resided an anastomosing network of bone trabeculae, having a zonal pattern of maturation from metaplastic woven to mature lamellar bone, with or without an associated xanthomatous component. Seven patients had a history of previous trauma, three with fractured ribs. Considering the relative infrequency of solitary rib lesions attributable to metastatic disease, it is proposed that in most cases there is no need for a diagnostic rib resection for these incidentally discovered, posttraumatic reparative lesions.

Aged↗
PubMed2000

Rib fractures induced by coughing: an unusual cause of acute chest pain.

We report three patients with stress fractures of the ribs induced by coughing. Standard radiographs of the chest and ribs did not reveal evidence of rib fractures in any of the patients. Bone scintigraphy, performed 1 to 2 weeks after initial onset of symptoms, showed a focal area of increased uptake along the chest wall in all cases. Thin section angulated helical CT directly visualized the subtle rib fractures. Initial diagnosis of a cough-induced fracture of the rib may be difficult because of the associated underlying disorder, and unnecessary examinations are commonly performed. Identification of a cough-induced fracture of the rib using helical CT may be clinically important to avoid unnecessary concern and additional examinations.

Adult↗
PubMed2001

Iliac crest biopsy versus rib segment resection for the detection of bone marrow isolated tumor cells from lung and esophageal cancer.

OBJECTIVE: The presence of isolated tumor cells in the bone marrow affects the prognosis of both esophageal cancer and non-small cell lung cancer (NSCLC). Therefore, preoperative assessment of isolated tumor cells may be useful to plan multimodality treatment. Rib segment resection at surgery provides adequate amounts of bone marrow for the detection of isolated tumor cells while bone marrow aspirate from the iliac crest does not. The iliac crest biopsy according to the Jamshidi technique procures a core of tissue apt for histology and not simply for cytology. The aim of this study was to compare the accuracy of iliac crest biopsy versus rib segment resection in the diagnosis of isolated tumor cells in order to obtain a useful preoperative approach. MATERIAL AND METHODS: Twenty-one consecutive patients (18 NSCLC, three esophageal cancer) were evaluated. None had chemotherapy prior to evaluation. Bone marrow was obtained preoperatively by iliac crest biopsy using the Jamshidi needle and at surgery by rib segment resection. Positive cytokeratin neoplastic cells were searched by immunohistochemistry on tissue sections from the iliac crest biopsies and by flow cytometry on cell suspensions from the rib segments. RESULTS: Isolated tumor cells were detected in the rib segments of ten patients. In all cases the Jamshidi needle biopsy was not diagnostic. CONCLUSION: Our results suggest that, if the diagnosis of bone marrow isolated tumor cells has clinical relevance, the preoperative assessment should be performed by rib segment resection or methods other than iliac crest aspirate or biopsy. Further investigation is needed to determine whether isolated tumor cells have a preferential spread to chest bones other than distant bone sites.

Adenocarcinoma↗
PubMed1998

Rib lesions and tuberculosis: the palaeopathological evidence.

SETTING: Tuberculosis diagnosis in past populations relies on lesions in the spine and major weight bearing joints of the body. Bone formation on visceral surfaces of ribs has also been suggested to be the result of chronic pulmonary disease. OBJECTIVE: To test whether these lesions are the result of pulmonary infection (most likely tuberculosis), by reviewing past work, and to discuss whether these lesions could be considered another diagnostic criterion for pulmonary tuberculosis. DESIGN: A review of the literature on new bone formation on ribs, and consideration of further evidence from archaeological skeletal material from the UK. RESULTS: Results from modern studies suggest that bone formation on ribs is often the result of pulmonary tuberculosis, that lesions are relatively common in archaeological skeletal material, and that some skeletons have rib lesions plus pathognomonic changes of tuberculosis. CONCLUSION: Evidence suggests that new bone formation on visceral surfaces of ribs should be considered a possible indicator of tuberculosis. If accepted, historical evidence, when correlated with rib data, produces closer approximations to the frequency of the disease in the past. This study indicates the importance of palaeopathology in identifying sometimes subtle lesions that may not be noted by clinicians because of their non-visibility on radiographs.

Humans↗
PubMed2000

[Autologous rib cartilage harvesting: operative procedure and postoperative pain reduction].

INTRODUCTION: In reconstructive surgery there is a growing demand for cartilage grafts. For small amounts of autologous tissue, cartilage from the nasal septum or ear concha is a sufficient and reliable tissue, but in cases of extensive defects or higher mechanical load autologous rib cartilage is a commonly used transplant. Nevertheless, a serious donor-site morbidity, especially postoperative pain, has to be taken into consideration. We present a modified technique for harvesting rib cartilage with a consecutive local pain therapy. TECHNIQUE: In contrast to the commonly used incision through all layers of tissue the described technique follows the anatomical structures of skin tension-lines, the fascial and muscle fibers and tissue sliding-planes. Starting with a transversal skin incisions 1.5 cm above the costal arch, longitudinal splitting of the rectus abdominis fascia and muscle, the rib cartilage of the ribs 6 to 8 can be exposed. Grafts in the size of at least 3 to 8 cm can be harvested under preservation of the perichondrium. This technique causes a high degree of stability and good function of the abdominal wall. POSTOPERATIVE PAIN THERAPY: After harvesting rib cartilage most patients complain about extensive postoperative pain. For adequate treatment the local application of a long-lasting anesthetic substance close to the intercostal nerves is helpful. The introduction of a peridural catheter opens the feasibility of continuously applying a local anesthetic for 3 to 4 days directly into the donor-site. This procedure reduces the need for general anesthetics dramatically and prevents further complications. DISCUSSION: This modified technique for harvesting rib cartilage diminishes the donor-site morbidity by reducing the risk of pneumothorax, hernias and functional deficits. Moreover, the local pain therapy assures postoperative wellness and mobility.

Anesthetics, Local↗
PubMed2000

Three-dimensional rotations of the thoracic spine after distraction with and without rib resection: a kinematic evaluation of the apical vertebra in rabbits with induced scoliosis.

An experimental model of induced scoliosis in New Zealand rabbits was studied to evaluate the effects of rib resection on the apical vertebra during distraction for scoliosis surgery. After concave distraction, three-dimensional rotations of the apical vertebra were measured using a motion analysis system, which included three cameras and six reflective markers. Distraction with rib resection on the convexity produced minimal rotations in the coronal plane (0.77 degrees), sagittal plane (0.96 degrees), and transverse plane (0.61 degrees) compared with no rib resection. The distraction maneuver with rib resection has no significant effect on derotation of the apical vertebra in the coronal and transverse plane, but slightly greater forward rotation was apparent in the sagittal plane (p < 0.05). Resection of three convex ribs directly corrects the rib prominence and does not seem to improve derotation.

Animals↗
PubMed1998

Cardiorespiratory effects of manually compressing the rib cage during tidal expiration in mechanically ventilated patients recovering from acute severe asthma.

OBJECTIVES: To determine the cardiorespiratory effects of manual expiratory rib cage compression in mechanically ventilated patients recovering from acute severe asthma; and to extrapolate these findings to emergency asthma management where ventilation cannot be achieved by positive-pressure ventilation. DESIGN: A prospective, clinical study. SETTING: Intensive care unit. PATIENTS: Four intubated, mechanically ventilated (volume-controlled), adult patients recovering from acute severe asthma. INTERVENTIONS: Patients were studied before, during, and after a 2- to 3-min period of manual compressions applied bilaterally over the lower rib cage (ribs 8 to 10) during consecutive tidal expirations. MEASUREMENTS AND MAIN RESULTS: Air flow (pneumotachograph), airway pressure, radial or brachial arterial pressure, and the hand pressure applied to the patient's rib cage were monitored and recorded on magnetic tape. Playback of the recorded data enabled measurement of changes in lung volume (air flow integration). Changes during rib cage compression consisted chiefly of small decreases in lung volume and peak inspiratory airway pressure that were only observed in the least obstructed patient and were fully reversed after the cessation of compressions. Air flow-time and air flow-volume plots demonstrated expiratory air flow limitation during essentially the entire tidal expiration in each patient, except the least obstructed patient. CONCLUSION: The results suggest that manual compression of the rib cage during consecutive tidal expirations would be ineffective in reducing pulmonary hyperinflation during the emergency management of asthma when air flow obstruction is so severe that ventilation cannot be achieved by positive-pressure ventilation.

Acute Disease↗
PubMedDate not supplied

Solitary hot spots in the ribs on bone scan: value of thin-section reformatted computed tomography to exclude radiography-negative fractures.

PURPOSE: The purpose of this study was to classify solitary, scintigraphy-positive and radiography-negative rib lesions and to clarify the features of rib fractures by using thin-section reformatted helical computed tomography (CT). METHODS: Forty-seven patients whose whole-body bone scans showed a solitary hot spot in a rib as their first abnormal scintigraphic finding and whose plain radiograph showed negative or indeterminate results were examined by thin-section reformatted CT. Final diagnosis was based on follow-up over a 20-month period. RESULTS: The final diagnosis included 17 cases of fractures where CT findings were fracture line, focal sclerosis, and callus formation. Fourteen ribs demonstrated intramedullary, focal osteosclerosis, and 8 ribs did not demonstrate any abnormalities. Four metastatic lesions appeared as intramedullary mixture of osteolysis and osteosclerosis, or bone destruction. Four intramedullary lesions with cystic appearance remained unchanged. CONCLUSIONS: Thin-section reformatted helical CT delineated minute, radiographically occult fractures of the rib. Excluding fractures, helical CT can avoid further unnecessary examinations.

Adult↗
PubMed1997

Internal stabilization of autogenous rib cartilage grafts in rhinoplasty: a barrier to cartilage warping.

Autogenous rib cartilage grafts have gained more widespread use in rhinoplasty as dorsal onlay grafts and columellar struts. However, the usefulness of rib as a donor site has been limited by difficulties with postoperative cartilage warping. We hypothesized that the internal stabilization of rib cartilage grafts with Kirschner wires would prevent warping. The costochondral cartilages of a fresh cadaver were harvested and carved into 4 x 10 x 40 nm blocks. A single 0.035-in K-wire was placed longitudinally into the center of each of the study specimens (n = 9), whereas no internal stabilization was utilized in the control group (n = 9). Over a 10-day study period, a mean of 2.2 degrees of warping was observed in the grafts with K-wires as compared to 8.9 degrees in the control group. This indicates that internal stabilization of rib grafts significantly reduces warping (p < 0.001). In a subsequent clinical study, 28 patients underwent placement of internally stabilized columellar struts (n = 19) and/or dorsal nasal grafts (n = 12) using autogenous rib cartilage. At a mean follow-up of 13.5 months (range 3 to 36 months), graft warping was not observed in any patient. Satisfactory aesthetic results were achieved in all but one patient, in whom mild displacement of a dorsal onlay graft occurred. Palatal extrusion of the K-wire occurred in 3 of the first 9 columellar struts. This prompted an alteration in technique with no subsequent extrusions. We conclude that the internal stabilization of autogenous rib cartilage grafts with K-wires effectively prevents graft warpage.

Adult↗
PubMedDate not supplied

Effect of the Harrington compression system on the correction of the rib hump in spinal instrumentation for idiopathic scoliosis.

To analyze the effect of the Harrington compression system on the rib hump in thoracic idiopathic scoliosis, intraoperative measurements were made on 21 cases during correction with the distraction system and after addition of the compression system. The data show that the compression system makes a major contribution to the correction of total rib deformity in over two-thirds of the patients, and the correction of the rib valley is much more significant than correction of the rib hump. Analysis of postoperative spine roentgenograms seems to indicate that the extent of the rib correction does not correlate with spine derotation as measured by the system of Nash and Moe. The improvement in rib correction achieved by addition of the compression system appears to result from changes centered about the costovertebral joints.

Adolescent↗
PubMed1994

Thoracoplasty for the treatment of rib prominence in thoracic scoliosis.

OBJECTIVES: The authors evaluated the reduction of rib prominence in patients who underwent thoracoplasty versus matched control patients who underwent fusion without thoracoplasty. SUMMARY OF BACKGROUND DATA: Correction in rib prominence with thoracoplasty is not well quantified in the literature. The role of rib bone graft as an alternative to iliac crest is unknown. METHODS: Fifty patients who underwent thoracoplasty were reviewed and compared with 26 patients who underwent fusion without thoracoplasty. Rib prominence, clinical data, and patient outcome were evaluated. RESULTS: The mean reduction in rib prominence was 71% in the thoracoplasty group and 17% in the control group. There was no difference in estimated blood loss, operative time, and length of hospitalization. Satisfaction with thoracoplasty was high. CONCLUSIONS: Thoracoplasty is more effective than fusion alone for reduction of rib prominence in thoracic scoliosis; it provides ample, effective bone graft for fusion.

Adult↗