Naeem uz Zafar Khan, Humera Khursheed, Saima Khan.
Congenital rib anomalies: A cause of respiratory distress in babies.
J Pak Inst Med Sci Jan ;4(1,2):222-5.

Three cases of congenital abnormalities of the ribs are being presented. This is a very rare condition and to save the patient`s life, urgent surgical intervention is required. Of the three, two paitents in whom surgical stabilization with rib grafts was possible, survived whereas the third patient could not be operated upon due to serious pulmonary infection and died.

Case No. 1 A 5 months old boy was admitted in the surgical ward with breathing difficulty. He had a history of recurrent chest infections. He was born at full term with no antenatal or natal problems. His immunization status was up to date. Other two siblings were perfectly healthy. On examination he looked ill and had tachypnoea and lower chest indrawing. He had gross abnormality of chest consisting of asymme try with a bulge on right side and decreased air entry on the left side. Chest X-ray revealed multiple rib anomalies with hemivertebrae in the thoracic region and right sided scoliosis. By the 3rd day of admission his condition deteriorated, he developed dehydration, cyanosis, marked acidosis and bilateral crepitations in the lungs. He had to be shifted to the paediatric intensive care unit (PICU) where he was managed on intravenous triple antibiotic therapy which consis ted of ampicillin, gentamycin and cefotaxime together with steam and oxygen inhalation, intravenous fluids and chest physiotherapy. Repeat chest X-ray revealed a dense area in the left upper zone. There was also evidence of pneumonic changes, more so on the right side. During the course of stay in the PICU he remained tachypnoeic and tachycardiac. A lung perfusion scan revealed perfusion defect in lower pole of the left lung. Right lung showed normal perfusion. By the eighth day of admission in PICU his condition improved and he was shifted to the ward. During his 3 day stay in the ward, he was treated with intravenous chloramphenicol. By the 3rd day he became very ill. He was tachypnoeic, had lower chest indrawing, developed bradycardia and respiratory failure with retention of carbon dioxide. Arterial blood gases showed severe respiratory acidosis and hypoxia. Attempts were made to resuscitate him but he showed no response and died due to cardiorespiratory failure.

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