Case Report
Congenital absence of ribs: Case report
Ausencia congénita de costillas: caso clínico
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Se aprecia el reducido tamaño de la silueta cardiaca con un índice cardiotorácico de 0,33 sugestivo de microcardia.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Adrián Lagoa, Lisandro Pérez, Sonia Veiras, Aurora Baluja, Javier García Carro, Angel L. Fernández" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Adrián" "apellidos" => "Lagoa" ] 1 => array:2 [ "nombre" => "Lisandro" "apellidos" => "Pérez" ] 2 => array:2 [ "nombre" => "Sonia" "apellidos" => "Veiras" ] 3 => array:2 [ "nombre" => "Aurora" "apellidos" => "Baluja" ] 4 => array:2 [ "nombre" => "Javier" "apellidos" => "García Carro" ] 5 => array:2 [ "nombre" => "Angel L." "apellidos" => "Fernández" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1134009620300140?idApp=UINPBA00004N" "url" => "/11340096/0000002700000002/v3_202005170613/S1134009620300140/v3_202005170613/es/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Congenital absence of ribs: Case report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "79" "paginaFinal" => "81" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Amr Abd-El Moneim Shalaby, Noran Mohamed Elnagdy" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Amr Abd-El Moneim" "apellidos" => "Shalaby" "email" => array:1 [ 0 => "dramrshalabycts@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Noran Mohamed" "apellidos" => "Elnagdy" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Cardiothoracic Surgery, Suez Canal University, Ismailia, Egypt" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Pediatrics and Neonatology, Suez Canal University, Ismailia, Egypt" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ausencia congénita de costillas: caso clínico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1025 "Ancho" => 905 "Tamanyo" => 164614 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Plain Chest X-ray showing absent 5th–8th ribs on left side.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Congenital absence of the ribs is a relatively rare condition with very rare documented cases especially for the absence of upper ribs; it can be present as an isolated anomaly or part of many congenital anomalies like in “Poland Syndrome”. Only few cases had been reported with absent ribs in Poland syndrome. Poland syndrome is a rare congenital disorder characterized by ipsilateral absence of pectoralis major muscle. This syndrome is associated with various anomalies such as ipsilateral syndactyly, brachidactyly, dextrocardia, herniation of lung, underdevelopment of upper ribs, aplasia or hypoplasia of breast, etc.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Generally, defects of the ribs do not occur alone. They are mostly associated with failure of development in the vertebral column and muscles of thoracic wall and the pleura are also frequently involved. Scoliosis is often present. Here we report a full term male newborn with absence of 5th–8th ribs on the left side with transient tachypnea. Diagnosis was done by clinical examination and confirmed with three-dimensional computed tomography (3D-CT) reconstruction imaging.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0015" class="elsevierStylePara elsevierViewall">A full-term male newborn was born after a normal pregnancy and cesarean section (gestational age 40 weeks, birth weight 3150<span class="elsevierStyleHsp" style=""></span>g). There was no relevant family history with negative consanguinity.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Routine physical examination was done, Systolic blood pressure was 95<span class="elsevierStyleHsp" style=""></span>mmHg, heart rate 140<span class="elsevierStyleHsp" style=""></span>Beats/min and respiratory rate was 64<span class="elsevierStyleHsp" style=""></span>Resp./min. Close monitoring and good oxygenation of the newborn were done. Chest examination showed asymmetrical chest respiratory movement with detected left middle thoracic region collapse during inspiratory movement, but the thorax regained symmetry in the expiratory phase. Palpation showed intact skin and subcutaneous tissue on left side of the thorax with non-palpable middle ribs on the left side on both anterior and posterior aspects. No inspected cyanosis or intercostal, subcostal or supra-clavicular muscles retractions. Auscultation of normal and symmetric breath sounds bilateral with no adventitial sounds. Cardiac examination showed normal regular heart rhythm without murmurs. The abdomen was lax on palpation, without palpable hepatosplenomegaly. Vertebral column and limbs had no obvious deformity. Muscle force and tension were within normal ranges.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Plain chest X-ray showed normal lung fields with absent 5th–8th ribs on left side (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), Plain chest Computed Tomography with 3D reconstruction (3D-CT) showed the complete absence of the left 5th–8th ribs, while the rest of the ribs had no deformities (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). No lung anomalies were detected. Echocardiography showed no intra cardiac congenital anomaly. Pelvic-abdominal ultrasound was done showing normal hepato-biliary system, pancreas, spleen, kidneys, ureters, and bladder. The infant was vitally stable with good feeding and in good health condition after one week of admission and routine clinical examination.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Congenital anomalies of ribs are not that common. Congenital absence of ribs is a rare condition without a certain etiology. It may be related to impaired blood supply during embryonic period, the absence either includes a segment or the whole rib, the underdevelopment of ribs is more common than the complete absence of ribs. The congenital absence of ribs is usually unilateral, it can involve the absence of single, multiple or even the whole thoracic cage and the first rib is usually unaffected. Supernumerary ribs, especially in the cervical region and less frequently in the lumbar region, are more often seen.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> As a rule defects of the ribs do not occur alone. There is usually some corresponding failure of development in the vertebral column, the muscles of the thoracic wall, and the pleura are also frequently involved. Scoliosis is often present.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> This is the first reported case of a full-term Egyptian newborn with congenital absence of the left 5th–8th ribs.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Diagnosis of rib deformity should be detected by the neonatologist at time of birth, superior rib deformities are easier to be detected that inferior ribs ones. However the diagnosis of rib deformities is highly vital to early avoid their complications. The absence of superior ribs can lead to thoracic scoliosis which affects the motor coordination and appearance. Deformities of inferior ribs have more serious complications like poor cardiac ejection fraction and lung herniation that may leads to recurrent chest infections, tachypnea, and dyspnea with very poor prognosis in such cases.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3–5</span></a> In our case, the absence of the left 5th–8th ribs did not affect the respiratory and cardiovascular functions. This may be because the inferior ribs were not included.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Diagnosis of absent ribs can be done by clinical examination, plain chest X-ray and confirmed by CT chest with 3D bone reconstruction. 3D-CT is vital to detect minor deformities and exclude lung anomalies.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> Congenital absence of ribs can be a part of other multiple congenital anomalies like trisomy 13 which has other malformations of the face and other regions and Poland Syndrome which includes absence of Pectoralis muscles and anomalies of the fingers. Regular routine skeletal examination and chest radiography can reduce the risk if missed diagnosis of congenital anomalies of ribs; although, 3D-CT is vital in confirmation of diagnosis as it can detect minor anomalies and exclude lung anomalies.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> Therefore, we performed 3D-CT reconstruction in addition to plain radiography to confirm our primary diagnosis and exclude lung anomalies.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Many anomalies may company congenital absence of ribs.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> In our case echocardiography and pelvic-abdominal ultrasound in addition full clinical examination and the already done 3D-CT to exclude multiple anomalies. Fortunately, no other obvious congenital anomaly was detected.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion, the congenital absence of ribs has been reported in few studies. In our case, the neonate did not present with any specific complications such as secondary dyspnea or poor cardiac ejection fraction. We recommend routine skeletal examination and plain chest radiography for neonates to reduce missed diagnosis and 3D-CT reconstruction as an effective tool to confirm the absence of multiple ribs.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical consideration</span><p id="par0055" class="elsevierStylePara elsevierViewall">The study was approved by the ethical committee of the faculty of medicine Suez Canal University.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The permission of the Suez Canal University hospital was taken.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Informed verbal voluntary consent from participants was obtained.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The participant was informed that he/she has the opportunity to decide to consent or not without intervention of any element of force, fraud, deceit, duress, or undue influence on the subject decision.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Information confidentiality was kept in analysis and data collection.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The techniques used in data collection, investigations were not harmful to screened population</p><p id="par0085" class="elsevierStylePara elsevierViewall">The research material and information was shared with others aiming advances in medical knowledge.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflict of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1336739" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1230905" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1336738" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1230906" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Ethical consideration" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-12-21" "fechaAceptado" => "2020-01-21" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1230905" "palabras" => array:3 [ 0 => "Congenital" 1 => "Absence" 2 => "Three-dimensional computed tomography" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1230906" "palabras" => array:3 [ 0 => "Congénito" 1 => "Ausencia" 2 => "Tomografía computarizada tridimensional" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Congenital absence of the ribs is a relatively rare condition especially for the absence of upper ribs; it can be present as an isolated anomaly or part of many congenital anomalies like in “Poland Syndrome”. Defects of the ribs do not occur alone; under development of vertebral column or absence of thoracic muscles can coexist. This is a report of a case of a full term male newborn with absence of 5th–8th ribs on the left side presented with transient tachypnea. Diagnosis was done by clinical examination and confirmed with three-dimensional computed tomography (3D-CT) reconstruction imaging.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La ausencia congénita de costillas es una situación relativamente rara, especialmente cuando se trata de las costillas superiores. Puede presentarse como anomalía aislada, o como parte de malformaciones congénitas de tipo «síndrome de Poland». Los defectos en las costillas no se producen de manera aislada, sino que pueden coexistir con subdesarrollo de la columna vertebral o ausencia de músculos torácicos. Presentamos el caso de un recién nacido a término con ausencia de la 5.ª a la 8.ª costillas en el lado izquierdo, que se presentó con taquipnea transitoria. El diagnóstico se realizó tras examen clínico, confirmándose mediante imagen de reconstrucción con tomografía computarizada tridimensional (3D-TC).</p></span>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1025 "Ancho" => 905 "Tamanyo" => 164614 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Plain Chest X-ray showing absent 5th–8th ribs on left side.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1143 "Ancho" => 1505 "Tamanyo" => 151332 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">CT chest with 3D reconstruction showing complete absence of left 5th–8th ribs while the rest of ribs are normal.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congenital absence of the ribs with malformed vertebrae" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 77 | 5 | 82 |
| 2024 October | 293 | 13 | 306 |
| 2024 September | 297 | 38 | 335 |
| 2024 August | 216 | 24 | 240 |
| 2024 July | 286 | 26 | 312 |
| 2024 June | 251 | 27 | 278 |
| 2024 May | 180 | 25 | 205 |
| 2024 April | 155 | 15 | 170 |
| 2024 March | 220 | 17 | 237 |
| 2024 February | 296 | 15 | 311 |
| 2024 January | 373 | 14 | 387 |
| 2023 December | 332 | 51 | 383 |
| 2023 November | 405 | 22 | 427 |
| 2023 October | 443 | 29 | 472 |
| 2023 September | 275 | 12 | 287 |
| 2023 August | 232 | 8 | 240 |
| 2023 July | 250 | 14 | 264 |
| 2023 June | 213 | 6 | 219 |
| 2023 May | 291 | 10 | 301 |
| 2023 April | 262 | 5 | 267 |
| 2023 March | 191 | 5 | 196 |
| 2023 February | 153 | 7 | 160 |
| 2023 January | 133 | 9 | 142 |
| 2022 December | 97 | 6 | 103 |
| 2022 November | 127 | 6 | 133 |
| 2022 October | 105 | 8 | 113 |
| 2022 September | 107 | 21 | 128 |
| 2022 August | 104 | 25 | 129 |
| 2022 July | 105 | 13 | 118 |
| 2022 June | 83 | 7 | 90 |
| 2022 May | 82 | 9 | 91 |
| 2022 April | 97 | 16 | 113 |
| 2022 March | 107 | 13 | 120 |
| 2022 February | 106 | 8 | 114 |
| 2022 January | 155 | 11 | 166 |
| 2021 December | 94 | 15 | 109 |
| 2021 November | 91 | 11 | 102 |
| 2021 October | 150 | 19 | 169 |
| 2021 September | 199 | 7 | 206 |
| 2021 August | 59 | 6 | 65 |
| 2021 July | 52 | 9 | 61 |
| 2021 June | 33 | 12 | 45 |
| 2021 May | 32 | 5 | 37 |
| 2021 April | 93 | 14 | 107 |
| 2021 March | 26 | 12 | 38 |
| 2021 February | 55 | 8 | 63 |
| 2021 January | 54 | 11 | 65 |
| 2020 December | 27 | 6 | 33 |
| 2020 November | 16 | 6 | 22 |
| 2020 October | 28 | 5 | 33 |
| 2020 September | 40 | 13 | 53 |
| 2020 August | 31 | 15 | 46 |
| 2020 July | 30 | 13 | 43 |
| 2020 June | 50 | 12 | 62 |
| 2020 May | 165 | 16 | 181 |
| 2020 April | 3 | 1 | 4 |
| 2020 March | 4 | 9 | 13 |
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