EXTERNAL THORAXGroup 6

Group 9Anita Damar Riyanti030.10.034Ariyanti Putri030.10.040

Attikasjah Riza W.030.10.041Attika Dini Ardiana030.10.042

Anatomy of Thorax

Bones of The Human Thorax

Sternum

Ribs

Costal Cartilage

Muscles of The Human ThoraxExternal IntercostalInnermost IntercostalInternal IntercostalLevators CostarumSubcostalisTransversus ThoracisDiaphragm

External Intercostal

Internal Intercostal

Innermost Intercostal

Levators Costarum

Subcostalis

Transversus Thoracis

Diaphragm

Disorder of Thorax

Pectus Excavatum (Funnel Chest)The most common congenital deformity of the anterior wall of the chest in which sternum and several ribs grow abnormally. It makes a caved in or a sunken appearance of the chest.

Pectus Carinatum (Pigeon Breast)Overgrowth of cartilage causing the sternum to protrude forward. Mostly caused by rachitis when they were child, but It may occur as a solitary congenital abnormality or in association with other genetic disorders. It makes a caved-out or rising appearance of the chest.

Rachitis rosary : The prominent knobs of bone at the costochondral joints which create the appearance of large beads under the skin of the rib cage, hence the name by analogy with the beads of a rosary.Scorbutic Rosary : The symptoms are exactly the same with Rachitis Rosary. But the difference is, this disease caused by Ascorbic Acid (vit c) deficiency

CRONKHITE-CANADA SYNDROME ASSOCIATED WITH RIB FRACTURES

Case PresentationWe report a case of a 58-year-old man who was admitted to hospital with a 6-month history of frequent diarrhea, intermittent hematochezia and a weight loss of 13 kg. On admission, physical examination revealed alopecia of the scalp, hyperpigmentation of the hands and soles, and dystrophy of the fingernails.

To make a diagnosis, he took;Laboratory test : The data showed him some hypocalsemia and hypoproteinemia signs.Esophagogastroduodenoscopy, Videocapsule endoscopy and colonoscopy: It revealed various sizes of generalized gastrointestinal polyps.Histological examination (biopsy specimen from the colon and stomach) : It showed him adenomatus polyps and inflammatory polyps.

So, The doctor diagnosed him that hes got CCS. And gave him corticosteroids for 24 days and nutritional support for 2 months. It succesfully improved his clinical condition.

Two months later, he was admitted to the hospital for the second time with frequent diarrhea and weight loss. In order to make a diagnosis, doctor suggested him to take another test:The chest radiography revealed fractures of the left sixth and seventh ribs. Examinations, including emission computed tomography, bone densitometry test, and other serum parameters, were performed. but still, doctors could not identify the definite etiology of the rib fractures.

One month later, the patient suffered from aggravating multiple rib fractures due to the ineffective treatment, persistent hypocalcaemia and malnutrition

Therere some results in pictures from the previous examination that indicated the patient to have CCS :Figure 1. Endoscopic views. Esophagogastroduodenoscopy showed diffuse polypoid lesions extending from cardia to the first part of the duodenum. A, Cardia; B, Stomach; C, Duodenum.

Figure 2. Endoscopic views. Video Capsule Endoscopy showed multiple herpes-like and strawberry-like polyps studded in most of the jejunum and ileum. A and B, Jejunum; C and D, Ileum.

Figure 3. Endoscopic views. Colonoscopy identified numerous, hyperemic, sessile and pedunculated polyps in the colorectum. A, Descending Colon; B, Transverse Colon

The second time he went to the hospital, he took a chest radiograph and it showed him that he had some fractures of his left sixth and seventh ribs (arrow).

And the third time he came again there were multiple fractures of the left fourth to seventh ribs (arrow) and right fifth to ninth ribs (arrow).

BackgroundCronkhite-Canada syndrome (CCS) is a rare acquired polyposis syndrome characterized by multiple gastrointestinal polyps with alopecia, nail dystrophy, and hyperpigmentation.The syndrome was first reported in 1955 by Cronkhite and Canada.So far, no definite etiology of CCS has been determined, though mental stress or physical fatigue is thought to be involved.And, no strong evidence to suggest a familial predisposition.

ConclusionThis is the first case of a CCS patient with multiple rib fractures. Although the association between CCS and multiple rib fractures in this case remains uncertain, we presume that persistent hypocalcaemia and malnutrition contribute to this situation. Besides, since prolonged corticosteroid therapy will result in an increased risk of osteoporotic fracture, CCS patients who accept corticosteroid for treatment could be potential victims of rib fracture.

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