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

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.