Education  |   May 2017
Supraclavicular Brachial Plexus Block in the Presence of a Cervical Rib
Author Notes
  • From the Department of Anesthesia and Pain Management, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada.
  • Address correspondence to Dr. Liu: monica.liu@uhn.ca
Article Information
Education / Images in Anesthesiology / Pediatric Anesthesia / Regional Anesthesia
Education   |   May 2017
Supraclavicular Brachial Plexus Block in the Presence of a Cervical Rib
Anesthesiology 5 2017, Vol.126, 979. doi:10.1097/ALN.0000000000001525
Anesthesiology 5 2017, Vol.126, 979. doi:10.1097/ALN.0000000000001525
A CERVICAL rib is an extra rib that arises from the seventh cervical vertebra due to a congenital abnormality. Reported incidences range between 0.05 and 3% and can occur unilaterally or bilaterally.1  We present an ultrasound image of the brachial plexus in the supraclavicular region of a patient who was incidentally found to have bilateral cervical ribs while scanning for a supraclavicular brachial plexus block. Scanning in the supraclavicular fossa revealed an unusually wide separation between the upper/middle and lower trunks of the brachial plexus above the subclavian artery. Proximal scanning revealed a hyperechoic line indicating the presence of a cervical rib. This was seen to lift and divide the lower trunk from the upper and middle trunks (fig.). A posteroanterior chest radiograph confirmed the presence of bilateral cervical ribs.
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