Focal chest wall protuberance due to forked ribs or cartilages: An analysis of 12 cases

Objective: The purpose of this article is to describe and summarize the clinical manifestations and radiographic features of focal bulging of chest walls in children using plain chest radiography and computed tomography (CT) scans. Methods: From 2008 to 2014, we identified 12 patients with forked ribs younger than 18 years of age. These patients received plain chest radiography and computed tomographic scans of the chest for focal anterior chest wall protrusion at the outpatient chest clinic of a children's facility. Results: A total of 12 patients (5 girls and 7 boys; age range, 2–12 years; median, 5 years) were enrolled in this study. Six patients had right-sided costal lesions, four had left-sided lesions, and two had anomalies on both sides. The most common rib involved was the 4th rib. Two patients with forked cartilages and one patient with forked rib were not detected in frontal radiograph but seen by CT scans only. Up to the time of this writing, the follow-up of patients revealed no progression of focal bulging. Conclusion: In otherwise healthy children with asymptomatic focal anterior chest wall bulging, forked ribs is a common cause of variation. The chest radiographs may be normal. Chest CT scans demonstrated forked ribs/cartilage as the cause of focal bulging of the chest wall unequivocally in such instances.