Rib Fracture

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Rib Fracture

Authors, Editors, Case Information Author: Drew Duerson, MD Affiliation: Nationwide Children's Hospital Senior Editor: William Denq, MD Clinical Vignette: 12 year old female soccer athlete presenting for chest wall pain for the past two weeks that was acutely worse two days prior after falling to the ground. Pain exacerbated by deep inspiration and running. Exam shows tenderness to palpation near the anterior 7th rib. Initial radiographs of ribs unremarkable. Type of Probe Used: 6-15 MHz linear array transducer SAX RIB DOPPLER LABELED Short axis image of the seventh rib showing hyperemia of periosteum. #2 - Video View Video Short axis view of the 7th rib from posterolateral to anteromedial #3 - Video View Video Short axis view of the 7th rib cortical irregularity with normal lung sliding SAX RIB DOPPLER UNLABELED Short axis image of the seventh rib with color doppler. SAX RIB LABELED Short axis image of the seventh rib with cortical irregularity and periosteal swelling. Adjacent intercostal muscles and underlying lung are normal. LAX RIB LABELED Long axis view of the anterior seventh rib showing focal area of cortical irregularity. SAX RIB UNLABELED Short axis image of the seventh rib, adjacent intercostal muscles, and underlying lung. LAX RIB UNLABELED Long axis view of the anterior seventh rib and overlying external oblique muscle. Interpretation Image Interpretation: The right anterior seventh rib has cortical irregularity with periosteal elevation and hyperemia on doppler imaging consistent with healing fracture. The adjacent intercostal muscle appeared normal. The underlying lung sliding is normal without evidence of pneumothorax or effusion. Teaching Pearl: Diagnostic ultrasound has been found to diagnose more fractures than radiography in patients that present with suspected rib injuries. Ultrasound also has been shown to require significantly less time to make this diagnosis. The ability to focus your scan based on your clinical exam and use pain with sonopalpation to your advantage, ultrasound should be considered as a first line test with any patient that presents with chest wall pain. Reference: Pishbin E, et al. Comparison of ultrasonography and radiography in diagnosis in rib fractures. Chin J Traumatol. 2017 Aug;20(4):226-228.
NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

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Authors, Editors, Case Information

SAX RIB DOPPLER LABELED

#2 - Video

#3 - Video

SAX RIB DOPPLER UNLABELED

SAX RIB LABELED

LAX RIB LABELED

SAX RIB UNLABELED

LAX RIB UNLABELED

Interpretation

UPCOMING EVENTS

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