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What causes absence of rib growth in an infant?

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Posted on Wed, 10 Dec 2014
Question: What would cause an infant's 8th rib to not grow attached to the rib above - only on one side?
doctor
Answered by Dr. Vivek Chail (1 hour later)
Brief Answer:
Might be vertebral or sternal abnormalities. Suggested X ray,CT scan chest.

Detailed Answer:
Hi XXX
Thanks for writing in to us.

I have read through your query in detail.
There are many reasons for an appearance of ribs in a child as mentioned by you.

Most of the rib appearances is due to an underlying congenital deformity. While most are minor deformities and seen involving only a particular area of the ribcage, there are some which occur with multisystem birth abnormalities and might be a part of a syndrome.

It is important to study the deformity in detail by doing X ray and then CT scan. This will show where exactly lies the problem. With the ribs, the vertebral columns and the intercostal muscles need to be evaluated in detail. In most cases, it arises due to an isolated point deformity in the spine called as scoliosis in which there is abnormal curvature of the spine to one side and this makes the ribs appear prominent.

Sternal deformities can also cause ribs to appear abnormal. In this the sternum can be depressed more towards one side and cause prominence of ribs. This can also lead to irregularity in distance between ribs.

A X ray and CT scan of chest will point to the exact diagnosis and further management and repair.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Vivek Chail (16 hours later)
This would be the front/anterior ribs. The ribs (5-7) almost seem to have curved under and inward. There is a dip under the curvation/ribs (feels like the 8th rib isnt connected) - what would cause this?
doctor
Answered by Dr. Vivek Chail (3 hours later)
Brief Answer:
Multiple possibilities exist and needs imaging for confirmation.

Detailed Answer:
Hi XXXX
Thanks for writing back with an update.

Assuming that the ribs are appearing focally prominent by birth, congenital rib anomalies is the commonest cause.

In rib anomalies itself there can be many conditions like forked ribs or multiple congenital rib dysplasias. Fusion may be seen in association with vertebral segmentation anomalies. Bone bridging is another type of rib anomalies which can be seen and involves a more focal joining of adjacent ribs by bone outgrowths. Intrathoracic and pelvic ribs are rare isolated anomalies. Intrathoracic ribs are usually supernumerary, are more often right-sided, and involve the middle of the thorax.

It is essential to perform imaging investigations and consider the condition as an individual case.

There can also be metabolic reasons of bone remodelling which can cause similar appearances but is less commoner than congenital ones.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (1 hour later)
Here's an example of what i am trying to explain
doctor
Answered by Dr. Vivek Chail (8 hours later)
Brief Answer:
Picture looks like unilateral pectus carinatum or its variants.

Detailed Answer:
Hi XXXX
Thanks for writing back with an update.

Having seen the picture attached, I would like to consider an unilateral pectus carinatum and its variations. It might still progressively increase with growth of the child and this has to be closely monitored.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (4 hours later)
Wouldnt pectus carnium only involve the sternum area? The sternum isnt felt or protruding - just the rib area. It almost feels like they are all pushed together curving under and pushing outward?
doctor
Answered by Dr. Vivek Chail (2 hours later)
Brief Answer:
Possibility of Poland syndrome or variants of pectus carinatum.

Detailed Answer:
Hi XXXX
Thanks for writing back with an update.

Sometimes, in variants of pectus carinatum the sternum position may not be obvious until at a later stage. The picture might also indicate a similar condition of the chest wall called Poland syndrome.

In Poland syndrome there is missing or abnormal muscles including the sternal head of the pectoralis major muscle on one side of the chest wall with or without rib abnormalities. This is also frequently associated with abnormalities of the hand, which often involve shortened fingers, partial fusion of the fingers, or both.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (49 minutes later)
The fingers are fine - they are actually rather long but definately not deformed. Attached is another picture taken laying down - in feeling under the lump area the ribs more or less curve down and inward pushing the top (lump) outwards. Again no pain/bruising in any of the area when touched or pushed .
doctor
Answered by Dr. Vivek Chail (2 hours later)
Brief Answer:
Unlikely to be a serious condition but requires detailed evaluation.

Detailed Answer:
Hi XXXX
Thanks for writing back with an update.

Lump is most likely a congenital problem and since birth. Poland syndrome can occur without hand deformities. Other chest wall deformities as mentioned earlier need also be thought of. As mentioned earlier, doing X ray or CT scan is best investigation. CT scan will give us detailed anatomy of the area. Most congenital deformities will not cause pain or bruising. It is difficult to make a confirmatory diagnosis without doing clinical examination and imaging. Please do not be worried as there is no immediate danger but proper detailed evaluation is required for treatment guidance.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (2 hours later)
One more inquiry - the picture posted is a posterior view of the spine - notice how it looks curved to the left? Is this where the normal infantile scoliosis normally curves?
doctor
Answered by Dr. Vivek Chail (28 minutes later)
Brief Answer:
Spine curvature in infantile scoliosis is similar to picture.

Detailed Answer:
Hi XXXX
Thanks for writing back with an update.

With reference to infantile scoliosis, it is reviewed in medical literature that the finding on clinical physical examination is a curve usually between the scapular blades or the thorax region of the spine and the spine curves to the left. This is seen in the picture of your baby and further imaging is needed to calculate angles. In cases where the angle is less than 20 degrees, there is no further progression and it can show resolution. A wait and watch approach is best in early childhood.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (2 minutes later)
So the curve in the picture is in the thorax region?
doctor
Answered by Dr. Vivek Chail (3 minutes later)
Brief Answer:
Curvature is in lower thoracic region.

Detailed Answer:
Hi XXXX
Thanks for writing back with an update.

The curvature in the picture appears to be in the lower thoracic region and is having a mild angulation with convexity to the left side of midline.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Vivek Chail

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What causes absence of rib growth in an infant?

Brief Answer: Might be vertebral or sternal abnormalities. Suggested X ray,CT scan chest. Detailed Answer: Hi XXX Thanks for writing in to us. I have read through your query in detail. There are many reasons for an appearance of ribs in a child as mentioned by you. Most of the rib appearances is due to an underlying congenital deformity. While most are minor deformities and seen involving only a particular area of the ribcage, there are some which occur with multisystem birth abnormalities and might be a part of a syndrome. It is important to study the deformity in detail by doing X ray and then CT scan. This will show where exactly lies the problem. With the ribs, the vertebral columns and the intercostal muscles need to be evaluated in detail. In most cases, it arises due to an isolated point deformity in the spine called as scoliosis in which there is abnormal curvature of the spine to one side and this makes the ribs appear prominent. Sternal deformities can also cause ribs to appear abnormal. In this the sternum can be depressed more towards one side and cause prominence of ribs. This can also lead to irregularity in distance between ribs. A X ray and CT scan of chest will point to the exact diagnosis and further management and repair. Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek