Bilateral cervical ribs on x-ray in a patient with thoracic outlet syndrome

A 27-year-old female patient presented with loss of the right radial pulse and right hand ischemia. A chest x-ray (A) shows bilateral asymmetric cervical ribs. A magnified view (B) shows a shorter right cervical rib compared with the left. Angiography confirmed arterial compression by the cervical rib as the source of embolic disease to the right hand.