Low attenuation areas in normal costal cartilages on CT: clinical implication and correlation with histology

While normal costal cartilages are known to be homogenous in attenuation on computed tomography (CT), they frequently show internal low attenuation. This study was performed to assess CT features of the low attenuation and to correlate them with histological features. Chest CT scans of 80 patients without chest wall abnormalities in the first eight decades of age with ten consecutive patients in each decade were reviewed. Histological examinations and CT of three costal cartilage specimens, one each from three cadavers, were done. Of the 80 patients, low attenuation areas were noted in 32% of the upper seven costal cartilages and in 64 patients (80%) without significant sexual difference (P = 0.503 and 0.786, respectively). The areas appeared more frequently in the lower costal cartilages than the upper ones, and were mostly symmetrical in distribution (82%). They were usually ill defined (74%) and similar in attenuation to the chest wall muscle (94%), located centrally (100%), and at most a half of the cartilage diameter. In all three cartilage specimens, central areas were grossly distinct from surrounding areas, and were corresponded to low attenuation areas on CT. At histological exam, the central areas showed multiple foci of vascularized loose connective tissue and fat on myxoid background, generally agreeing with the previous description of cartilage canals, a kind of nutrient channel. In conclusion, normal costal cartilages can show central low attenuation areas, which are typically symmetrical in distribution and at most a half of the cartilage diameter.