# Percutaneous cryoneurolysis for intercostal neuralgia due to bifid rib in a pediatric patient

## TL;DR

A 3-year-old child with chest pain caused by a rare rib anomaly was successfully treated with a minimally invasive nerve freezing procedure.

## Contribution

This case report introduces percutaneous cryoneurolysis as a novel treatment for intercostal neuralgia caused by bifid ribs in pediatric patients.

## Key findings

- Percutaneous cryoneurolysis provided sustained pain relief in a child with intercostal neuralgia from a bifid rib.
- The procedure was performed without complications and showed lasting benefits at 4 months post-treatment.
- Bifid ribs may be an under-recognized cause of chronic chest wall pain in children.

## Abstract

Bifid ribs are rare congenital anomalies, usually asymptomatic and discovered incidentally on imaging. However, they can cause significant pain, posing diagnostic and therapeutic challenges, particularly in pediatric populations. We report a case of a 3-year-old female with chronic anterior chest wall pain attributed to a bifid right fourth rib. Imaging confirmed the anomaly without associated soft tissue masses. After transient symptom relief with lidocaine patches and intercostal nerve blocks, she underwent successful percutaneous image-guided cryoneurolysis of the right third to fifth intercostal nerves. The patient experienced marked pain relief post-procedure without complications, with sustained benefit at 4 months. Bifid ribs may be an under-recognized cause of intercostal neuralgia in children. Image-guided percutaneous cryoneurolysis may represent a safe and effective treatment option for symptomatic relief.