Abnormal Number of Fetal Ribs on 3-Dimensional Ultrasonography

Abstract

Objective. The purpose of this study was to describe the clinical importance of an abnormal number of fetal ribs. Methods. A retrospective study of all fetuses that were found to have an abnormal number of ribs during routine ultrasonographic examinations was performed. Volume data sets of the fetal ribs were acquired by either static 3‐ or 4‐dimensional volume contrast imaging in plane C. In all cases, a meticulous survey of the fetal anatomy was performed, and prenatal and postnatal records were reviewed. Results. Seventy‐five fetuses were found retrospectively to have an abnormal number of ribs. Ultrasonographic examinations were done between 14 and 31 weeks' gestation (mean, 21.8 weeks; median, 23 weeks). More than 24 ribs were found in 28 fetuses (37%), and fewer than 24 ribs were found in 47 (63%). Additional anomalies were found in 22 fetuses (29%). Cardiovascular anomalies were detected in 10 fetuses. Seven fetuses had renal anomalies. Two fetuses had mild ventriculomegaly, and 1 fetus had holoprosencephaly. Lung dysplasia was found in 2 cases. One fetus had enlarged nuchal translucency with wormian bones. Termination of pregnancy was performed in 3 cases because of major malformations. The other 19 fetuses with associated abnormalities and the 53 without associated anomalies were born alive with only minor anomalies. Conclusions. An abnormal number of fetal ribs is an isolated finding in most cases. It may also be seen with major anomalies; however, more frequently the anomalies are minor, and the overall prognosis is good.

Incidental imaging findings of congenital rib abnormalities – a case series and review of developmental concepts

“…Homeobox genes also play a role in tumour suppression and carcinogenesis, since both development and neoplasia juggle with cell proliferation and differentiation [4,21]. This can explain the association between an abnormal number of ribs and cancer, proven by studies in which cervical ribs and subnumerary ribs (less than 24) are correlated with childhood neoplasia [7]. In our opinion, this data justifies enclosing supernumerary (cervical and lumbar) and aplastic ribs in a distinct developmental category, as results of homeotic transformations.…”

“…Congenital anomalies of the ribs can occur as single malformations or in association with other abnormalities [29]. However, the majority of congenital rib anomalies appear as isolated findings [5][6][7], mostly asymptomatic [8,10].…”

Increased prevalence of abnormal vertebral patterning in fetuses and neonates with trisomy 21

“…So far, this hypothesis has not been confirmed and should be further investigated in future studies. The fetal vertebral column and the number of thoracic ribs can be assessed using 2-and 3-dimensional ultrasonography [21,49]. The value of prenatal 3-dimensional ultrasonography for the assessment of cervical ribs has not been investigated.…”

Unilaterale pulmonale Agenesie, Aplasie und Dysplasie

“…Sie kann kombiniert sein mit einem nicht-immunologischen Hydrops fetalis, diff erentialdiagnostisch kommen Bronchialatresien, kongenitales Emphysem, und CCAM in Betracht [24,26,27] . Anomalien der fetalen Rippen k ö nnen auf eine Lungendysplasie hinweisen [28] . In der Farb-Doppler-Sonografi e ist der fehlende Nachweis pulmonaler Gef ä ß e richtungsweisend [25] .…”