Costal Cartilage Mineralization and Gender

Costal cartilage follows a typical mineralization pattern based on gender. In males, the typical calcification pattern on frontal radiographs consists of parallel lines extending medially from the ends of the anterior ribs (blue arrows). On lateral radiographs, these calcifications appear as circles.

In females, the pattern can be central or globular. The central pattern, also known as the "wagging tongue" pattern, can also be seen in up to 2% of males. These are linear ossific tongues arising from the center of the rib at the costochondral junction (pink arrow).

The globular pattern, may be seen in postmenopausal women and consists of smooth, rounded, centrally indistinct foci of ossification in the central portion of the costal cartilage.

References

Ontell FK, Moore EH, Shepard JA, Shelton DK. The costal cartilages in health and disease. Radiographics. 1997 May-Jun;17(3):571-7.