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All Posts in Category: Flattened / Unfolded Rib

The Unfolded Infected Rib – Rib Tuberculosis and CT Scan

This is a 34-years old man with a swelling over the left anterior chest wall. The CT scan shows the collection as well as the osteolytic lesions of the ribs and the sclerosis, typical of an infection like tuberculosis.
The unfolded rib image however puts it all in perspective. The osteolytic lesions and the sequestra with surrounding sclerosis involving 4th – 6th are just so much better appreciated.
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Unfolded / Flattened Rib – Fibrous Dysplasia of the Rib

Fig. 1: A simulated radiograph created from CT scan data shows an expansile lesion of the right 5th rib (arrow).

Fig. 1: A simulated radiograph created from CT scan data shows an expansile lesion of the right 5th rib (arrow).

This 29-years old lady had a chest radiograph for cough and fever. It showed an expansile lesion of the right posterior 5th rib (Fig. 1). This pattern typically occurs with either fibrous dysplasia or enchondroma, though the commonest entity in an asymptomatic individual is fibrous dysplasia (1).

Nevertheless a CT scan was performed. Thick maximum intensity projection (MIP) axial (Fig. 2a) and coronal (Fig. 2b) images show an expansile osteolytic lesion with thickening of the cortical margins at places along with a subtle ground-glass matrix. This again is typical of fibrous dysplasia.

Fig. 2 (A,B): Thick MIP axial (A) and coronal (B) images show the expansile osteolytic lesion well with cortical thickening and thinning with a ground-glass matrix.

Fig. 2 (A,B): Thick MIP axial (A) and coronal (B) images show the expansile osteolytic lesion well with cortical thickening and thinning with a ground-glass matrix.

Fig. 2 (A,B): Thick MIP axial (A) and coronal (B) images show the expansile osteolytic lesion well with cortical thickening and thinning with a ground-glass matrix.

Fig. 2 (A,B): Thick MIP axial (A) and coronal (B) images show the expansile osteolytic lesion well with cortical thickening and thinning with a ground-glass matrix.

The Flattened/Unfolded Rib image (Fig. 4) reconstructed on the new Syngo Via platform (2, 3) with automatic numbering of the ribs shows this lesion extremely well.

Fig. 3. The Flattened/Unfolded Rib image with automatic numbering shows the lesion (arrow) with the expansion, size and dimensions exquisitely demonstrated.

Fig. 3. The Flattened/Unfolded Rib image with automatic numbering shows the lesion (arrow) with the expansion, size and dimensions exquisitely demonstrated.

Since the patient and orthopedic surgeon were still concerned about the diagnosis, a CT guided biopsy (Fig. 4) was performed that confirmed the presence of a fibro-osseous lesion.

Fig. 4: A CT guided biopsy (arrow) was performed that confirmed the diagnosis of a fibro-osseous lesion.

Fig. 4: A CT guided biopsy (arrow) was performed that confirmed the diagnosis of a fibro-osseous lesion.

Because of the curvature of the rib, it can be difficult to visualize rib lesions, especially subtle fracture on routing reading, even with multiplanar reconstructions (MPRs) and MIPs. The new Siemens Syngo Via has a Bone Reading module that automatically flattens out the ribs and spine and allows quick and accurate evaluation of rib pathology, both fractures (3) and tumors (4,5).

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