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: A 12-year-old female soccer athlete presented for chest wall pain for the past two weeks that was acutely worse two days prior after falling to the ground. Pain was exacerbated by deep inspiration and running. Exam was notable for tenderness to palpation near the anterior 7th rib. Initial radiographs of the ribs were unremarkable. Type of Probe Used: 6-15 MHz linear array transducer Unlabeled Long Axis View of the Anterior Right 7th Rib Unlabeled Long Axis View of the Anterior Right 7th Rib Labeled Long Axis View of the Anterior Right 7th Rib Labeled Long Axis View of the Anterior Right 7th Rib showing focal area of cortical irregularity. Unlabeled Short Axis View of the Anterior Right 7th Rib Unlabeled Short Axis View of the Anterior Right 7th Rib Labeled Short Axis View of the Anterior Right 7th Rib Labeled Short Axis View of the Anterior Right 7th Rib with cortical irregularity and periosteal swelling. Adjacent intercostal muscles and underlying lung are normal. Unlabeled Short Axis View of the Anterior Right 7th Rib with Color Doppler Unlabeled Short Axis View of the Anterior Right 7th Rib with Color Doppler Labeled Short Axis View of the Anterior Right 7th Rib with Color Doppler Labeled Short Axis View of the Anterior Right 7th Rib with Color Doppler showing hyperemia of the periosteum. #7 - Video View Video Short axis cine of the 7th rib from posterolateral to anteromedial showing a cortical irregularity #8 - Video View Video Short axis cine of the 7th rib cortical irregularity with normal lung sliding 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: Ultrasound may detect more rib fractures than radiography in patients with focal rib trauma because the probe can be placed directly over the point of maximum tenderness to evaluate the bony cortical surface. Sonographic findings include cortical step-off or discontinuity, periosteal elevation, hematoma, and Doppler hyperemia at the fracture site. When appropriate, it can be important to evaluate the pleural line deep to the fracture for lung sliding and consider additional imaging for severe trauma, respiratory symptoms, or suspected intrathoracic injury. References: 1. Gilbertson J, Pageau P, Ritcey B, et al. Test characteristics of chest ultrasonography for rib fractures following blunt chest trauma: a systematic review and meta-analysis. Ann Emerg Med. 2022;79(6):529-539. doi:10.1016/j.annemergmed.2022.02.006 2. Abu-Zidan FM, Alao DO, Cevik AA. Point-of-care ultrasound (POCUS) diagnosis of rib fractures. World J Emerg Surg. 2026;21(1):1. doi:10.1186/s13017-025-00665-9 3. Pishbin E, Ahmadi K, Foogardi M, Salehi M, Seilanian Toosi F, Rahimi-Movaghar V. Comparison of ultrasonography and radiography in diagnosis of rib fractures. Chin J Traumatol. 2017;20(4):226-228. doi:10.1016/j.cjtee.2016.04.010
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

Unlabeled Long Axis View of the Anterior Right 7th Rib

Labeled Long Axis View of the Anterior Right 7th Rib

Unlabeled Short Axis View of the Anterior Right 7th Rib

Labeled Short Axis View of the Anterior Right 7th Rib

Unlabeled Short Axis View of the Anterior Right 7th Rib with Color Doppler

Labeled Short Axis View of the Anterior Right 7th Rib with Color Doppler

#7 - Video

#8 - Video

Interpretation

UPCOMING EVENTS

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