Article

Ultrasonographic evaluation of costal cartilage fractures unnoticed by the conventional radiographic study and multidetector computed tomography

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Abstract

Introduction Rib fractures are the most common injuries resulting from blunt chest trauma. However, costal cartilage fractures are almost invisible on chest X-rays unless they involve calcified cartilage. The sensitivity of conventional radiography and computed tomography for detecting rib fractures is limited, especially in cases where rib cartilage is involved. Therefore, this study was designed to evaluate the sensitivities of chest wall ultrasonography, clinical findings, and radiography in the detection of costal cartilage fractures. Materials and methods A total of 93 patients presenting with a high clinical suspicion of rib or sternal fractures were recruited for radiological workup with posterior–anterior (PA) chest radiographs, oblique rib views, sternal views, computed tomography, and chest ultrasound between April 2008 and May 2010. There were 47 men and 46 women, and the mean age of the patients was 51.8 ± 15.9 years (range 17–78 years). These patients with minor blunt chest trauma showed no evidence of rib fractures on conventional radiography and computed tomography, and no evidence of other major fractures. Chondral rib fractures were detected by using ultrasonography on a 7.5-MHz linear transducer. Results Of the total 93 patients, 64 (68.8%) showed chondral rib fractures, whereas 29 (31.2%) did not. The mean number of chondral rib fracture sites detected in 64 patients was 1.8 ± 0.8 (range 1–5). Subperiosteal hematoma was the most common finding associated with costal cartilage fractures (n = 14, 15.0%), followed by sternal fracture (n = 9, 9.7%). However, subperiosteal hematoma was also noticed in 1 (1.1%) of the patients without costal cartilage fractures, and sternal fractures in 7 patients (7.5%). Discussion The results of this study suggest that ultrasonography may be a useful imaging method for detecting costal cartilage fractures overlooked on conventional radiographs and computed tomography in patients with minor blunt chest trauma. Early ultrasonographic evaluation can give more accurate information than clinical and radiologic evaluation in detecting costal cartilage fractures and sternal fractures that are overlooked on conventional radiography and computed tomography after minor blunt chest trauma.

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... The incidence and location of fractures detected by US and radiography were then compared. The injured rib location was classified as upper (1-4), mid (5)(6)(7)(8), and lower (8)(9)(10)(11)(12) hemithorax and anterior, lateral (anterolateral, posterolateral), and posterior parts of a rib. Besides, patients were examined for hemothorax and pneumothorax. ...
... Many studies have found remarkable differences in the detection of rib fractures by US and radiography, and steel has suggested the US as the more sensitive approach [7][8][9]. Studies that used both PA and oblique view to detect rib fractures reported an overall close positive diagnostic rate to the US [10,11]. In our study, we used only plain PA images for the detection of rib fracture. ...
... In anterior and lateral hemithorax, thin, soft tissue allows well detection of superficially located ribs, and these areas can be easily examined in supine and lateral decubitus positions. Most studies that compared the radiographic imaging and US for detecting rib fractures [6,10,14] used the patients' pain location to determine the pathology: thus, they reduced the examination time and focused on the probably fractured bone. In our study, methodologically we examined the patient throughout the entire chest in order to avoid misdiagnosed rib fracture and also aim to standardize the US examination. ...
Article
Introduction: The most common injury resulting from blunt chest trauma is a rib fracture (25%) which is usually visible on radiographs. However, radiographs sometimes cannot show fractures, especially those in cartilage, unless they're densely calcified. The present study aimed to investigate the role of ultrasonography (US) in detecting rib fractures with minor blunt chest trauma and comparing its success with posteroanterior (PA) chest radiography.Methods: Patients with minor blunt chest trauma who had previously undergone US and radiography to assess suspected rib fractures, between June 2017– March 2019, were included. Radiography was obtained in the PA projection. US was performed by a radiologist who identified fractures by the disruption of the anterior margin of the rib on the US. The incidence and location of the fractures detected by US and radiography were then compared.Results: Totally 126 patients were included in the study. Ninety-eight patients (78%) were admitted to the hospital for the first time, and 28 patients (22%) for the second time (they previously admitted to the other hospitals and were evaluated as ‘normal’ by radiography). A total of 108 fractures ( in 79 patients (63%) ) were detected based on radiography and US examination, while 47 patients (37%) had no diagnostic evidence of fracture. All fractures were correctly detected by ultrasonography (100%), whereas radiography revealed 16 fractures (14.81%). A statistically significant difference in diagnostic capability was found between patients diagnosed by radiography and US (p=0.001).Conclusion: Ultrasonographic imaging is significantly superior to radiography in terms of accuracy in diagnosing rib fractures. Ultrasound was found to be significantly superior to radiography regardless of trauma site, localization, and location. Even though some rib areas are inaccessible on ultrasonographic evaluation, rapid evaluation of the most affected areas is most effective with ultrasonography when it comes to minor energy chest trauma. For this reason, the US increases the accuracy of diagnosis in minor chest traumas and rib fractures and decreases the repetitive referral of patients to health institutions by reducing the missed diagnosis.Keywords: Rib fractures, thoracic injuries, trauma, ultrasonography, radiography
... The rib fractures are the most common thoracic injury. Fractures exist in only 32 -42% of symptomatic patients [2,8]. The main symptom of rib fracture is the pain in the area of movement or the non-moving injury area [9]. ...
... Obesity and co-existing lung disorders may adversely affect the quality of radiography, which is a challenge to interpret and diagnose the image [6]. Besides, some patients may not provide a suitable position during the plain radiography procedure and may cause limitations in the radiological examination [8]. Rib fractures could be detected in 50-80% of patients with minor chest trauma by conventional radiological examination for various reasons [8]. ...
... Besides, some patients may not provide a suitable position during the plain radiography procedure and may cause limitations in the radiological examination [8]. Rib fractures could be detected in 50-80% of patients with minor chest trauma by conventional radiological examination for various reasons [8]. ...
... 7 26-29 A prospective diagnostic test accuracy study design was used in all but one of the included studies, with Martino et al 29 using a case series design. 29 In terms of the use of the reference standard, one study used CT scan and chest radiograph, 19 two used bone scintigraphy, 20 26 one used chest radiograph 22 and three used a repeat LUS 21 23 25 28 29 In addition, the methods used in the studies differed, with six studies investigating rib fracture diagnosis using LUS in patients with no evidence of rib fracture on chest radiograph 19 22-25 29 and six studies 7 18 19 25 26 28 investigating rib fracture diagnosis using both LUS and chest radiograph in patients with clinical suspicion of rib fractures. ...
... 7 19 20 22-29 Furthermore, the use of LUS in the diagnosis of patients with rib fractures was reported superior to targeted, oblique rib radiographs in two studies 7 28 Review and MDCT (in detection of costal cartilage fractures) in another study. 19 The actual number of rib fractures identified by LUS compared with chest radiograph was also reported to be higher in four of the studies. [24][25][26][27] In contrast, two studies reported that a certain number of fractures were evident on chest radiograph, but missed on LUS. ...
... LUS was also reported to be superior to chest radiograph and other radiographic modalities due to a number of clinical factors including; it is unaffected by respiratory motion, it leads to a reduction in the use of expensive CT and MRI scan and in radiation exposure, immediate interpretation and availability of results is possible, LUS is portable permitting use in prehospital environment and finally, it can be used by non-radiologists. 19 21-23 25 28 Three key disadvantages of LUS in the diagnosis of rib fractures were proposed in a number of the studies including; LUS is time-consuming, it can be painful for the patient and that the retroscapular and infraclavicular portions of the first rib were inaccessible. 7 19 24 25 Furthermore, large breasts and obesity were also reported to be limitations of LUS. ...
Article
Introduction It is well-recognised that the detection of rib fractures is unreliable using chest radiograph. The aim of this systematic review was to investigate whether the use of lung ultrasound is superior in accuracy to chest radiography, in the diagnosis of rib fractures following blunt chest wall trauma. Methods The search filter was used for international online electronic databases including MEDLINE, EMBASE, Cochrane and ScienceDirect, with no imposed time or language limitations. Grey literature was searched. Two review authors completed study selection, data extraction and data synthesis/analysis process. Quality assessment using the Quality Assessment of Diagnostic Accuracy Studies Tool (QUADAS-2) was completed. Results 13 studies were included. Overall, study results demonstrated that the use of lung ultrasound in the diagnosis of rib fractures in blunt chest wall trauma patients appears superior compared with chest radiograph. All studies were small, single centre and considered to be at risk of bias on quality assessment. Meta-analysis was not possible due to high levels of heterogeneity, lack of appropriate reference standard and poor study quality. Discussion The results demonstrate that lung ultrasound may be superior to chest radiography, but the low quality of the studies means that no definitive statement can be made.
... There have been no explicit standards for classifications of causes of injuries. The causative factors responsible for isolated costal cartilage fractures could be aligned in two ways, either based on patient population or based on nature of injury ( Table 1) [4]. Drivers and occupants were the most commonly affected population and traffic accident injury was the most common cause [4], whereas fist injury only accounted for 6.3% [4]. ...
... The causative factors responsible for isolated costal cartilage fractures could be aligned in two ways, either based on patient population or based on nature of injury ( Table 1) [4]. Drivers and occupants were the most commonly affected population and traffic accident injury was the most common cause [4], whereas fist injury only accounted for 6.3% [4]. In general, isolated costal cartilage fractures often occur in the lower ribs and are typically caused by the direct impact from a blunt chest trauma [5]. ...
... The causative factors responsible for isolated costal cartilage fractures could be aligned in two ways, either based on patient population or based on nature of injury ( Table 1) [4]. Drivers and occupants were the most commonly affected population and traffic accident injury was the most common cause [4], whereas fist injury only accounted for 6.3% [4]. In general, isolated costal cartilage fractures often occur in the lower ribs and are typically caused by the direct impact from a blunt chest trauma [5]. ...
Article
Isolated costal cartilage fractures are benign and rare. A 65-year-old man had a sustained chest pain after a fist punch in the past month. A three-dimensional computed tomography revealed left 7th and 8th costal cartilage fractures with fracture dislocations. As he refused an open fracture reduction, he was advised to have a rest with subsequent follow-up. Ultrasound screening is recommended in patients with sustained posttraumatic chest pains in order to rule out possible costal cartilage fractures. The therapeutic regimen generally depends on the location and severity of the fracture.
... In such cases, the patient would still complain of constant pain, which would lead the clinician to suspect malingering or would give cause for further confusion. Ultrasound examination is known to be more sensitive than plain chest radiography or CT in detecting such cartilage fractures (Lee et al., 2012). Furthermore, although plain chest radiography typically detects hemothorax at approximately 150 mL, ultrasound imaging can detect the condition with a volume as low as 40 mL, making it a highly sensitive diagnostic tool (Röthlin et al., 1993). ...
... The finding is consistent with what the present study found. Lee et al. (2012) reported that ultrasound examination was effective in detecting costal cartilage fractures previously undetected with plain chest radiography or CT. Griffith et al. (1999) reported that, whereas the diagnostic sensitivity of plain chest radiography for sternal fracture was 15%, that of the ultrasound was 90%. ...
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Article
Simple radiography is the best diagnostic tool for rib fractures caused by chest trauma, but it has some limitations. Thus, other tools are also being used. The aims of this study were to investigate the effectiveness of ultrasonography (US) for identifying rib fractures and to identify influencing factors of its effectiveness. Between October 2003 and August 2007, 201 patients with blunt chest trauma were available to undergo chest radiographic and US examinations for diagnosis of rib fractures. The two modalities were compared in terms of effectiveness based on simple radiographic readings and US examination results. We also investigated the factors that influenced the effectiveness of US examination. Rib fractures were detected on radiography in 69 patients (34.3%) but not in 132 patients. Rib fractures were diagnosed by using US examination in 160 patients (84.6%). Of the 132 patients who showed no rib fractures on radiography, 92 showed rib fractures on US. Among the 69 patients of rib fracture detected on radiography, 33 had additional rib fractures detected on US. Of the patients, 76 (37.8%) had identical radiographic and US results, and 125 (62.2%) had fractures detected on US that were previously undetected on radiography or additional fractures detected on US. Age, duration until US examination, and fracture location were not significant influencing factors. However, in the group without detected fractures on radiography, US showed a more significant effectiveness than in the group with detected fractures on radiography (P=0.003). US examination could detect unnoticed rib fractures on simple radiography. US examination is especially more effective in the group without detected fractures on radiography. More attention should be paid to patients with chest trauma who have no detected fractures on radiography.
... Although diagnostic ultrasound (US) of the chest is not typically utilized for the evaluation of chest wall pain, point-of-care US has been shown to be feasible for detection of rib fractures in the setting of minor trauma in emergency settings, with 27/94 (29%) detecting rib fractures after negative chest radiography [22]. Another study showed US to detect costochondral fractures in 68.8% of radiographically occult cases [23]. US of the chest has several diagnostic limitations, including technical difficulties related to posterior location of fractures, and soft-tissue penetration in patients with large breasts [22]. ...
Article
Chest pain is a common reason that patients may present for evaluation in both ambulatory and emergency department settings, and is often of musculoskeletal origin in the former. Chest wall syndrome collectively describes the various entities that can contribute to chest wall pain of musculoskeletal origin and may affect any chest wall structure. Various imaging modalities may be employed for the diagnosis of nontraumatic chest wall conditions, each with variable utility depending on the clinical scenario. We review the evidence for or against use of various imaging modalities for the diagnosis of nontraumatic chest wall pain. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
... In cases of blunt trauma, TUS has been shown to be more sensitive than chest radiographs at the detection of rib fractures, with an increase in diagnostic sensitivity from 50% to 90%. 5,6 Fractures are identified by a gap or a discontinuity in the cortex or a "step" if the rib is dislocated. 2 TUS can be used to identify underlying hematomas adjacent to the rib fracture. They can have varying degrees of echogenicity depending on erythrocyte density and can form denser echoes due to e78 Ultrasound Corner ...
... La búsqueda obtuvo 329 referencias, de las que se preseleccionaron seis: la revisión de Morley et al (24) y cinco estudios individuales (49)(50)(51)(52)(53). Sin embargo, en la revisión no se realizan recomendaciones sobre la radiografía esternal en el diagnóstico y manejo del paciente con sospecha de fractura esternal y/o costal, y de los cinco estudios individuales preseleccionados se descartan tres: uno por tratarse de un caso (49), otro por valorar la utilidad de la ecografía en detectar fractura esternal sólo en pacientes con radiografía esternal y TC negativas (50) y el tercero por evaluar el valor clínico de las fracturas esternales diagnosticadas sólo por TC ((51). ...
... Despite those systematic reviews and numerous studies using CXR as the reference, there are only two studies that used CT as a reference test for US. One of those studies aimed to detect costal cartilage fractures, not rib fractures (16). The only study that used CT as the reference test for US aimed to evaluate the utility of US in all kinds of thoracic injuries, including rib fractures (13). ...
Article
-Background: Rib fractures are the most common complications of blunt chest trauma (BCT). Computed tomography (CT) is the modality of choice for BCT, but with several disadvantages. Ultrasonography (US) is an inexpensive, readily available, and relatively harmless imaging alternative. However, a direct comparison of the sono-graphic evaluation of the rib as a whole with CT as a reference has not been performed to date. Objective: This study aimed to compare the diagnostic accuracy of US with CT for the detection of rib fractures in patients who presented to emergency department (ED) with BCT. Methods: We included a convenience sample of adult patients who presented to the ED with thoracic pain after BCT in the last 24 h in this prospective, observational, diagnostic accuracy study. The diagnostic utility of US performed by an emergency physician was compared with thorax CT. Results: The final study population included 145 patients. The diagnostic accuracy of US was 80% with a sensitivity of 91.2% and specificity of 72.7% for the detection of any rib fracture (positive likelihood ratio 3.4 and negative likelihood ratio 0.12). If we considered each rib separately, the sensitivity of US decreased to 76.7% and specificity increased to 82.7% (81.3% accuracy). Conclusions: A negative US of the site of the highest tenderness and neighboring ribs in a patient with BCT who presented to the ED with lateralizing pain decreases the possibility of a rib fracture significantly. However, a positive US performs poorly to specify the exact location and number of the fractured ribs.
... La búsqueda obtuvo 329 referencias, de las que se preseleccionaron seis: la revisión de Morley et al (24) y cinco estudios individuales (49)(50)(51)(52)(53). Sin embargo, en la revisión no se realizan recomendaciones sobre la radiografía esternal en el diagnóstico y manejo del paciente con sospecha de fractura esternal y/o costal, y de los cinco estudios individuales preseleccionados se descartan tres: uno por tratarse de un caso (49), otro por valorar la utilidad de la ecografía en detectar fractura esternal sólo en pacientes con radiografía esternal y TC negativas (50) y el tercero por evaluar el valor clínico de las fracturas esternales diagnosticadas sólo por TC ((51). ...
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Los traumatismos en general son una causa muy frecuente de muerte y discapacidad. Globalmente constituyen la quinta causa de muerte y la sexta de discapacidad moderada y severa. En España, existen pocos registros sobre la epidemiología de esta enfermedad, si bien los datos son probablemente extrapolables de otros países desarrollados. Según un registro de traumatismo grave del Grupo de Trabajo de Trauma y Neurointesivismo de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMYCYUC) (1) las caídas accidentales son la causa más frecuente de enfermedad traumática grave en nuestro país (20 % de los casos), seguido de los pacientes precipitados (16 %), accidentes de coche (15,3 %) y accidentes de motocicleta (14,3 %). Si hablamos específicamente del traumatismo torácico, según el mismo registro, el tórax es la segunda región más frecuentemente afectada en estos pacientes (46,4 %), sólo superada por la cabeza. No obstante, la lesión codificada con mayor frecuencia es la fractura de un número igual o mayor a tres costillas, que se documenta en el 17,1 % de los afectados. La edad constituye un factor de riesgo conocido en el paciente traumatizado, doblándose la mortalidad a igualdad de lesiones en mayores de 65 años. Además, el aumento exponencial de la multimorbilidad en este segmento de la población hace que la probabilidad de complicaciones, especialmente el de hemorragia, aumente significativamente, pues un porcentaje elevado se encuentra bajo tratamiento de antiagregación y/o anticoagulación (12,4 % en el registro de la SEMYCYUC). El envejecimiento progresivo de la población, unido a una mejor calidad de vida de nuestros ancianos, hace de estos pacientes un grupo de especial fragilidad donde edad, multimorbilidad, tratamiento crónico y riesgo de caídas confluyen. En otro estudio publicado en 2015 (2), en el que se analizaban los cambios durante la última década en la incidencia y las características de los pacientes politraumatizados en Navarra, se objetivó un incremento significativo en el número de caídas en los ancianos, pasando de ser la causa de un 9 % a un 26 % de los pacientes traumatizados atendidos en un servicio de urgencias. Tratándose, por tanto, de un problema de salud grave que conlleva cifras de morbimortalidad elevada y que además supone un gran consumo de recursos humanos y económicos, resulta esperable y evidente que existan múltiples protocolos para estandarizar la atención al paciente politraumatizado grave, siendo el propuesto por el American College of Surgeons (ACS) (Advanced Trauma Life Support o ATLS) el más difundido a nivel mundial. No obstante, para el traumatismo no grave y concretamente, para el traumatismo torácico no grave (donde cabe esperar una mayor prevalencia) no existe hasta la fecha ningún documento de calidad científica suficiente ni GPC que oriente a los profesionales sanitarios sobre su correcto diagnóstico, homogeinize la práctica clínica y ayude a la utilización racional de los recursos disponibles. Esta guía surge como necesidad de responder a ese problema de salud, partiendo de una iniciativa de la Sociedad Española de Cirugía Torácica (SECT). Asimismo, se han encontrado algunas prácticas de escaso valor que no aportan beneficios al proceso de atención al paciente y que podrían ser eliminadas repercutiendo positivamente en la eficiencia y la seguridad de los cuidados prestados.
... Sự khác biệt này có ý nghĩa thông kê với p < 0,05. Kết quả nghiên cứu cũng phù hợp với một số nghiên cứu khác trên thế giới trong đó có tỷ lệ nam/nữ là 5,7/1, tuổi trung bình là 46,5 [10]; độ tuổi hay gặp chấn thương ngực là 20-60 [8], [10]. Điều này phù hợp với thực tế là do tính chất công việc, thói quen đi lại, môi trường làm việc, hút thuốc lá và các yếu tố ngoại cảnh khác nên nam giới thường mắc bệnh hô hấp, lồng ngực nhiều hơn nữ, kể cả chấn thương ngực. ...
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Article
Background: Chest X-ray was recommended as the first choice for lung pathology for longtime. Transthoracic ultrasonography can explore effectively the anomaly of chest wall, the pleura and the peripheral lung parenchyma. This diagnostic tool was not routinely applying in Viet Nam. Objective of this study is to confirm the supplementary value for chest radiograph of transthoracic ultrasound. Material and methods: Cross descriptive study from 4/2013 to 11/2013 on 32 patients with pleural, lung and chest wall pathology by ultrasound and chest radiograph at Hue University Hospital. Results: 17 trauma and 15 non trauma patients with almost man (81.2%) at the working-age (71.9%). The most common clinical sign is chest pain (84.4%), then pleural effusion, shortness of breath, glare pain point (31-34%). The ultrasound is more sensitive than chest X ray in diagnosis of pleural effusion, rib fracture, pleural thickening... The fracture of the 8th–10th ribs are well diagnosed on US were missed on chest radiograph. The characteristic of pleural effusion and the minimum of pleural thickening were explored on US only. Conclusion: The supplementary value of transthoracic US for chest X ray in diagnosis the anomaly of pleura and chest wall is now justified, especially in case traumatism. Key words: X-ray, lung pathology, transthoracic
... Its role in trauma is well defined, and its ability to detect haemothorax and pneumothorax is already proven [12][13][14][15]. While its role in evaluating chest trauma is clear, its role in detecting rib fractures is less clear [16][17][18][19][20][21][22][23][24][25]. There is no agreement regarding the role of PoCUS in this application because it is a painful examination. ...
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Article
Blunt thoracic injury (BTI) constitutes a common presentation in emergency department: rib fractures are the most common injuries. Chest X-ray (CXR) has a limited sensitivity to identify rib fractures. We perform this retrospective study in our emergency department collecting all patients with BTI during an 18-month period. PoCUS was performed prior to acquire CXR or CT. We evaluated 1672 patients with BTI, and we reported rib fractures in 689 patients (41.21%). PoCUS was performed in 190 patients. PoCUS in emergency medicine has an increasing role, especially in BTI, but less clear is its role in detecting ribs fracture. PoCUS seems to be an effective method for diagnosing rib fracture in patients with blunt chest trauma if collaborative and with a well-isolated trauma. We used the trick of patients' self-positioning probe in the most painful site, and this could reduce the time and the pain of the examination.
... Only 10-60% of rib injuries are visible on plain film radiography (2,6,(7)(8)(9)24) . Sonography is especially helpful in diagnosing occult fractures where no direct injury occurred, where bone dislocation is absent, or where it is costal cartilage that is fractured (2,4,7,25) . Breaks show on ultrasound as linear cortical discontinuity (Fig. 4), sometimes with a very slight, step-like, dislocation present. ...
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Article
The chest wall is a vast and complex structure, hence the wide range of pathological conditions that may affect it. The aim of this publication is to discuss the usefulness of ultrasound for the diagnosis of benign lesions involving the thoracic wall. The most commonly encountered conditions include sternal and costal injuries and thoracic lymphadenopathy. Ultrasound is very efficient in identifying the etiology of pain experienced in the anterior chest wall following CPR interventions. Both available literature and the authors’ own experience prompt us to propose ultrasound evaluation as the first step in the diagnostic workup of chest trauma, as it permits far superior visualization of the examined structures compared with conventional radiography. Sonographic evaluation allows correct diagnosis in the case of various costal and chondral defects suspicious for cancer. It also facilitates diagnosis of such conditions as degenerative lesions, subluxation of sternoclavicular joints (SCJs) and inflammatory lesions of various etiology and location. US may be used as the diagnostic modality of choice in conditions following thoracoscopy or thoracotomy. It may also visualize the fairly common sternal wound infection, including bone inflammation. Slipping rib syndrome, relatively little known among clinicians, has also been discussed in the study. A whole gamut of benign lesions of thoracic soft tissues, such as enlarged lymph nodes, torn muscles, hematomas, abscesses, fissures, scars or foreign bodies, are all easily identified on ultrasound, just like in other superficially located organs.
... Conventional radiography cannot reveal CC fractures, but computed tomography (CT), MR imaging, and ultrasonography have proven to be useful in their depiction (10)(11)(12)22,23). Previous publications of CC injuries have focused on posttraumatic evaluation weeks or months after the initial trauma (10,11). ...
Article
Purpose To assess the incidence of costal cartilage (CC) fractures in whole-body computed tomographic (CT) examinations for blunt trauma and to evaluate distribution of CC fractures, concomitant injuries, mechanism of injury, accuracy of reporting, and the effect on 30-day mortality. Materials and Methods Institutional review board approval was obtained for this retrospective study. All whole-body CT examinations for blunt trauma over 36 months were reviewed retrospectively and chest trauma CT studies were evaluated by a second reader. Of 1461 patients who underwent a whole-body CT examination, 39% (574 of 1461) had signs of thoracic injuries (men, 74.0% [425 of 574]; mean age, 46.6 years; women, 26.0% [149 of 574]; mean age, 48.9 years). χ(2) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Interobserver agreement was calculated by using Cohen kappa values. Results A total of 114 patients (men, 86.8% [99 of 114]; mean age, 48.6 years; women, 13.2% [15 of 114]; mean age, 45.1 years) had 221 CC fractures. The incidence was 7.8% (114 of 1461) in all whole-body CT examinations and 19.9% (114 of 574) in patients with thoracic trauma. Cartilage of rib 7 (21.3%, 47 of 221) was most commonly injured. Bilateral multiple consecutive rib fractures occurred in 36% (41 of 114) versus 14% (64 of 460) in other patients with chest trauma (OR, 3.48; 95% CI: 2.18, 5.53; P < .0001). Hepatic injuries were more common in patients with chest trauma with CC fractures (13%, 15 of 114) versus patients with chest trauma without CC fractures (4%, 18 of 460) (OR, 3.72; 95% CI: 1.81, 7.64; P = .0001), as well as aortic injuries (n = 4 vs n = 0; P = .0015; OR, unavailable). Kappa value for interobserver agreement in detecting CC fractures was 0.65 (substantial agreement). CC fractures were documented in 39.5% (45 of 114) of primary reports. The 30-day mortality of patients with CC fractures was 7.02% (eight of 114) versus 4.78% (22 of 460) of other patients with chest trauma (OR, 1.50; 95% CI: 0.65, 3.47; P = .3371). Conclusion CC fractures are common in high-energy blunt chest trauma and often occur with multiple consecutive rib fractures. Aortic and hepatic injuries were more common in patients with CC fractures than in patients without CC fractures. (©) RSNA, 2017.
Article
This systematic review and meta-analysis aimed to comprehensively review the current evidence of the critical role of ultrasound (US) imaging in fracture detection. A systematic search was conducted in different databases to find the studies of bone fracture evaluation using US imaging. Quality assessment of diagnostic accuracy studies (QUADAS-2) was used as a standard tool to evaluate the methodological quality of the reviewed studies. We included 30 studies of 3370 searched publications. These studies varied based on their subjects in sample size, from 14 to 204, and were performed in different countries between 2000 and 2019. Bone fracture diagnosis accuracy with the US in comparison to standard imaging (radiography) was evaluated using the specificity and sensitivity measures, as well as positive and negative predictive values. The sensitivities for the US varied between 85% and 100%, and the specificities were 73% and 100% for different body sites. In addition, the positive and negative predictive values ranged from 67.5 to 100% and 86–100%, respectively. The overall power of US in fracture diagnosis was 59.5% (range 20–96%). Applying non-invasiveness and cost-effectiveness acoustic wave which does not penetrate sound waves through bone may be a superb substitute option compared to the current diagnostic radiography. Previous studies showed that US imaging is significantly accurate for bone fracture diagnosis from different sites; however, more studies are needed so that it can be extended to all body regions.
Article
Study objective Chest ultrasonography has been reported as an accurate imaging modality and potentially superior to chest radiographs in diagnosing traumatic rib fractures. However, few studies have compared ultrasonography to the reference standard of computed tomography (CT), with no systematic reviews published on the topic to date. Our objective was to summarize the evidence comparing the test characteristics of chest ultrasonography to CT in diagnosing rib fractures. Methods This study was performed and reported in adherence to PRISMA guidelines. We searched 5 databases plus gray literature from inception to October 2021. Two independent reviewers completed study selection, data extraction, and a QUADAS-2 risk of bias assessment. Summary measures were obtained from the Hierarchical Summary Receiver Operating Characteristic model. Results From 1,660 citations, we identified 7 studies for inclusion, of which 6 had available 2×2 data for meta-analysis (n = 663). Of the 6 studies, 3 involved emergency department-performed ultrasonography and 3 radiology-performed ultrasonography. Chest ultrasonography had a pooled sensitivity of 89.3% (95% confidence interval [CI], 81.1 to 94.3) and specificity of 98.4% (95% CI, 90.2 to 99.8) compared with CT imaging for the diagnosis of any rib fracture. The finding of a fracture on ultrasonography, defined as an underlying cortical irregularity, was associated with a +likelihood ratio (LR) of 55.7 (95% CI, 8.5 to 363.4) for CT diagnosed rib fracture, while the absence of ultrasonography fracture held a -LR of 0.11 (95% CI, 0.06 to 0.20). We were unable to detect a difference in test characteristics between emergency department- and radiology-performed ultrasonography (P=.11). The overall risk of bias of included studies was high, with patient selection identified as the highest risk domain. Conclusion Chest ultrasonography is both sensitive and highly specific in diagnosing rib fractures following blunt trauma.
Article
Chest, abdominal, and groin pain are common patient complaints that can be due to a variety of causes. Once potentially life-threatening visceral causes of pain are excluded, the evaluation should include musculoskeletal sources of pain from the body wall and core muscles. Percutaneous musculoskeletal procedures play a key role in evaluating and managing pain, although most radiologists may be unfamiliar with applications for the body wall and core muscles. US is ideally suited to guide these less commonly performed procedures owing to its low cost, portability, lack of ionizing radiation, and real-time visualization of superficial soft-tissue anatomy. US provides the operator with added confidence that the needle will be placed at the intended location and will not penetrate visceral or vascular structures. The authors review both common and uncommon US-guided procedures targeting various portions of the chest wall, abdominal wall, and core muscles with the hope of familiarizing radiologists with these techniques. Procedures include anesthetic and corticosteroid injection as well as platelet-rich plasma injection to promote tendon healing. Specific anatomic structures discussed include the sternoclavicular joint, costochondral joint, interchondral joint, intercostal nerve, scapulothoracic bursa, anterior abdominal cutaneous nerve, ilioinguinal nerve, iliohypogastric nerve, genitofemoral nerve, pubic symphysis, common aponeurotic plate, and adductor tendon origin. Relevant US anatomy is depicted with MRI correlation, and steps to performing successful safe US-guided injections are discussed. Confidence in performing these procedures will allow radiologists to continue to play an important role in diagnosis and management of many musculoskeletal pathologic conditions. ©RSNA, 2021.
Article
Background: Surgical stabilization of rib fractures (SSRF) significantly improve the outcomes of patients with rib fractures. Ultrasound is a specific modality for localizing rib fractures. We hypothesized that use of perioperative ultrasound localization of fracture sites optimizes surgical approach and clinical outcomes. Methods: We performed a retrospective cohort study of adult patients undergoing SSRF, and compared those with and without adjunctive perioperative US fracture localization. Our primary outcome was improved surgical efficiency as measured by incision length and total operative time. Secondary clinical outcomes included numeric pain score on follow up visit and daily morphine milligram equivalent prescribed within 30 days from discharge. Results: We performed 49 surgical rib fixations between 2015 and 2020; of which, 13 (26.5%) additionally underwent ultrasound localization (26.5%). There were no significant differences between groups in age, gender, number of ribs repaired, or days till surgery. More patients in the ultrasound group had non-flail chest wall injury (76.9% vs 27.8%, p=0.003). Use of perioperative US was associated with shorter incision length (median: 9 vs 15.5 cm, p=0.0001), shorter operative time (median 120 vs 174 min, p=0.003), less daily MME (25 vs 68 mg, p=0.009), and reduced numeric pain score on follow up (median 4 vs 7, p=0.05).Conclusions: Use of perioperative ultrasound localization of rib fractures to optimize surgical approach for SSRF was associated with reduced incision length, operative time, and opioid requirements on patient discharge. We recommend considering routine perioperative localization to improve surgical approach and efficiency during SSRF.Level of evidence: Level III, Therapeutic.
Article
Plain radiography is often considered a first-line diagnostic tool and gold standard for bony fractures. This case series and brief literature review highlight the need for increased training in musculoskeletal sonography. A case is presented of a distal radial fracture that was not detected on radiography but diagnosed with sonography on the same day. Similarly, two fractures of the distal fibula were diagnosed using sonography after negative radiographs at follow-up appointments, led to misdiagnoses and mismanagement. A fourth case is presented to show an acute rib fracture diagnosed by sonography. These cases emphasize the importance of musculoskeletal sonography training in the diagnosis of acute fractures and its underutilization at the bedside. Collaboration between sonographers and physicians may increase utilization of musculoskeletal sonography which in turn may improve patient care and outcomes.
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Purpose: Rib fractures are the most common skeletal thoracic injuries resulting from blunt chest trauma. Half of the rib fractures are not detected upon a precise physical evaluation and radiographs. Recently ultrasonography (USG) has been investigated to detect rib fractures. But based on literature the usefulness of USG varies widely. This study was conducted to investigate the role of USG in the detection of possible rib fractures in comparison with radiography. Methods: In this cross-sectional study, consecutive patients with minor blunt chest trauma and suspected rib fractures presenting in Imam Reza Hospital located in Mashhad-Iran, between April 2013 and October 2013 were assessed by USG and radiography. The radiography was performed in a posteroanterior (PA) chest projection and oblique rib view centered over the area of trauma. The time duration spent in taking USG and radiography were recorded. The prevalence and location of fractures revealed by USG and radiography were compared. Results: Sixty-one suspected patients were assessed. The male to female ratio was 2.4:1 (43 men and 18 women) with a mean ± SD age of (44.3 ± 19.7) years. There were totally 59 rib fractures in 38 (62.3%) patients based on radiography and USG, while 23 (37.7%) patients had no diagnostic evidence of rib lesions. USG revealed 58 rib fractures in 33 (54.1%) of 61 suspected patients and radiographs revealed 32 rib fractures in 20 (32.8%) of 61 patients. A total of 58 (98.3%) rib fractures were detected by USG, whereas oblique rib view and PA chest radiography showed 27 (45.8%) and 24 (40.7%) rib fractures, respectively. The average duration of USG was (12 ± 3) min (range 7-17 min), whereas the duration of radiography was (27 ± 6) min (range 15-37 min). The kappa coefficient showed a low level of agreement between both USG and PA chest radiography (kappa coefficient = 0.28), and between USG and oblique rib view (kappa coefficient = 0.32). Conclusion: USG discloses more fractures than radiography in most patients presenting with suspected rib fractures. Moreover USG requires significantly less time than radiography.
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A vertically integrated latch-up based n-p-n bidirectional diode, which is analogous to an open-base bipolar junction transistor, is demonstrated for bipolar resistance-change memory selector application. A maximum current density of >50 MA/cm2 and a selectivity of >104 are observed at a fast switching speed of within 10 ns. The high selectivity as a consequence of the sudden latch-up process is feasible owing to the positive-feedback process initiated by impact ionization. The optimization of the turn-on voltage is comprehensively investigated by numerical device simulation, which ensures the promising potential of the latch-up based selector device.
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Introduction: Lesions of the thoracal sceleton can sometimes present a problem in radiological diagnosis. The aim of the study is to investigate the value of ultrasound at thoracal trauma. Methods: Eighty patients with thoracal trauma and suspected rib fracture or sternal fracture were entered in the study. The results of the thorax X-ray and the thorax sonography were compared. Results: Eighty patients took part in the study (35 women, 45 men, average age of 50.4 years). In the X-ray, the diagnosis of rib fracture was certain in 21 patients (26%), in ultrasound 41 patients (51%) had definitive signs of rib fracture. Because of multiple fractures, 37 ribs could be granted as surely fractured in the X-ray, sonographically 75 fractures could be detected. All of the 6 patients with suspected sternum fracture showed clear fracture signs in X-ray and also in ultrasound. Conclusions: Ultrasonography is an easy, rapidly available and cost-effective method to obtain information in suspected rib/sternum fracture. The diagnosis of rib fracture can be granted about twice as often in ultrasound than in X-ray, clear signs of rib/sternum fracture can be obtained sonographically in a reliable and very sensitive way.
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Article
This study was undertaken to compare the sensitivities of sonography and radiography for revealing acute rib fracture. Chest radiography and rib sonography were performed on 50 patients with suspected rib fractures. Sonography was performed with a 9- or 12-MHz linear transducer. Fractures were identified by a disruption of the anterior margin of the rib, costochondral junction, or costal cartilage. The incidence, location, and degree of displacement of fractures revealed by radiography and sonography were compared. Sonography was performed again after 3 weeks in 37 subjects. At presentation, radiographs revealed eight rib fractures in six (12%) of 50 patients and sonography revealed 83 rib fractures in 39 (78%) of 50 patients. Seventy-four (89%) of the 83 sonographically detected fractures were located in the rib, four (5%) were located at the costochondral junction, and five (6%) in the costal cartilage. Repeated sonography after 3 weeks showed evidence of healing in all reexamined fractures. Combining sonography at presentation and after 3 weeks, 88% of subjects had sustained a fracture. Sonography reveals more fractures than does radiography and will reveal fractures in most patients presenting with suspected rib fracture. Further scientific studies are needed to clarify the appropriate role for sonography in rib fracture detection.
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Article
Rib fractures are the most common injuries resulting from blunt chest trauma. The sensitivity of chest X-rays in showing the rib fractures is limited particularly in those involving the cartilage part of the rib. We investigated the possible rib fractures, those overlooked on chest X-rays, with the use of ultrasonography in minor blunt chest trauma. A total of 37 patients, with minor blunt chest trauma showing no evidence of a rib fracture on chest X-rays, were examined with ultrasonography performed with a 7.5-MHz linear transducer. Logistic regression analysis was done to outline the clinical predictors of these insidious rib fractures. A total of 15 (40.5%) patients showed rib lesions, whereas 22 (59.5%) patients had no evidence of rib lesions. Fracture of the rib associated with a subperiosteal hematoma was the most common finding in ten (66.7%) patients followed by the fracture of the rib alone in four (26.7%) patients, and subperiosteal hematoma alone in one (6.7%) patient. A total of eight (53.3%) patients had bony rib fractures, whereas seven (46.7%) patients had chondral rib fractures. Age (P=0.617), gender (P=0.552), type of etiology (P=0.954), duration of pain (P=0.234) and site of trauma (P=0.740) did not appear as significant predictors for these rib fractures. However, the involved part of the rib showed a significant correlation with either age (P=0.042) or duration of pain (P=0.033). Bony rib fractures significantly occurred in elderly patients, and the duration of pain in patients with bony rib fractures was significantly longer than that of patients with chondral rib fractures. Ultrasonography is a useful imaging method in showing the rib fractures those overlooked on chest X-rays in minor blunt chest trauma, and no significant clinical feature exists as a predictor for these insidious fractures. However, bony rib fractures significantly occur in elderly patients and result in a longer duration of pain.
Article
Studienziel: Knöcherne Läsionen am Thorax nach stumpfen Traumen können röntgenologisch oft Schwierigkeiten bereiten. Ziel dieser Studie war es, die Wertigkeit der Thoraxsonographie im klinischen Alltag im Vergleich zu Thoraxröntgen einschließlich Zielaufnahme zu untersuchen. Methode: 103 Patienten/innen (32 Frauen, 71 Männer, Durchschnittsalter 54,3 Jahre) mit einem anamnestisch vorliegenden stumpfen Thoraxtrauma und Verdacht auf Rippen- und Sternumfraktur fanden Aufnahme in die Studie. Ergebnisse: Radiologisch gelang der Nachweis einer Rippenfraktur bei 27 Patienten/innen (30%), sonographisch bei (58%) Patienten/innen. Bedingt durch Mehrfachfrakturen bei ein und denselben Patienten/innen lag die Gesamtzahl der sicher nachgewiesenen Rippenfrakturen radiologisch bei 49, im Ultraschall konnten 101 frakturierte Rippen nachgewiesen werden. Minimale Pleuraergüsse einschließlich Pleurawinkelergüssen fanden sich sonographisch in 31 Fallen (32%), radiologisch konnten nur 18 Fälle (19%) erfaßt werden. Bei 6 Patienten (6%) fanden sich ausgedehntere pleurale Flüssigkeitsansammlungen, die alle sowohl sonographisch als auch röntgenologisch diagnostiziert wurden. Bei allen sieben Patienten (7%) mit Sternumfraktur war die Diagnose sowohl radiologisch als auch sonographisch zu stellen. Schlußfolgerung: Sonographisch gelang der Nachweis von Rippenfrakturen etwa doppelt so häufig wie im Thoraxröntgen einschließlich Zielaufnahme. Die Sonographie sollte als ergänzende Untersuchung besonders in der ventralen Region und in der Frage nach Flüssigkeitsansammlungen eingesetzt werden. Bei Sternumfrakturen zeigte sich keine Differenz beider Methoden. Therapeutische Konsequenzen können sich gerade bei polytraumatisierten Patienten ohne Zeitverlust nach einer sonographischen Primärdiagnostik ergeben. Weitere Aspekte eines sicheren Frakturnachweises liegen im Rahmen von Gutachtertätigkeiten und in der Beurteilung der Dauer von Arbeitsunfähigkeiten.
Article
High-resolution real-time sonography of the musculoskeletal system of infants and young children is being used with increasing frequency, in part because of the inability of plain film radiography to visualize unossified cartilage. Real-time sonography now plays an important role in the evaluation of infantile hip dysplasia, as well as in the identification and aspiration of joint effusion. The purpose of this essay is to illustrate clinical situations in which sonography of the elbow is helpful.
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The Trauma Score (TS) has been revised. The revision includes Glasgow Coma Scale (GCS), systolic blood pressure (SBP), and respiratory rate (RR) and excludes capillary refill and respiratory expansion, which were difficult to assess in the field. Two versions of the revised score have been developed, one for triage (T-RTS) and another for use in outcome evaluations and to control for injury severity (RTS). T-RTS, the sum of coded values of GCS, SBP, and RR, demonstrated increased sensitivity and some loss in specificity when compared with a triage criterion based on TS and GCS values. T-RTS correctly identified more than 97% of nonsurvivors as requiring trauma center care. The T-RTS triage criterion does not require summing of the coded values and is more easily implemented than the TS criterion. RTS is a weighted sum of coded variable values. The RTS demonstrated substantially improved reliability in outcome predictions compared to the TS. The RTS also yielded more accurate outcome predictions for patients with serious head injuries than the TS.
Article
Since the diagnosis of rib fractures caused by blunt thoracic trauma is often missed on X-ray, attempt have been made to detect unknown fractures with ultrasound. Ultrasound was initially researched, as a diagnostic technique in a preliminary study of 10 patients with known rib fractures. Subsequently, in the main study, 21 patients with clinically suspected rib fractures but normal thoracic X-rays were examined with ultrasound, and rib fractures were detected in 16 patients. The diagnosis of rib fractures by ultrasound was substantiated by an increase of activity in the technetium scintigram in 11 of 11 patients. We found further increases of activity in the scintigram in two more ribs in 7 of these 11 patients. This finding is explained by the presence of nondislocated rib fractures that are veiled to ultrasound when a disconnection of the rib's contour is missed during respiration. The diagnostic procedure is explained with reference to case studies. In summary, findings recorded in this study showed that ultrasound investigation is a more reliable method of diagnosis than X-rays examination.
Article
Fractures and epiphyseal injuries in the region of the elbow are uncommon in infants and young children, but they can be very difficult to diagnose and delineate accurately. In addition to plain radiography, invasive or costly procedures such as arthrography and magnetic resonance imaging traditionally have been used to evaluate these injuries. We used high-resolution real-time ultrasonography to evaluate a suspected injury of the elbow in seven infants and one ten-year-old child. Three of the infants had a physeal separation, two had a supracondylar fracture, and two had no skeletal injury. The child had an avulsion fracture of the lateral epicondyle of the humerus and an effusion in the joint. The ultrasonographic findings were confirmed by arthrography in three patients, by open reduction in one, and by follow-up radiographs in all. None of the ultrasonographic studies were performed with the patient under general anesthesia. Ultrasonography, a readily available, non-invasive technique, can be used to evaluate the unossified epiphysis about the elbow of infants and young children; to demonstrate dislocations, fractures, and physeal separations; to identify a hinge of soft tissue at the site of a fracture; to identify interposition of soft tissue between fracture fragments; and to aid in the planning of closed and open reductions.
Article
Interest of high frequency ultrasonography in rib cartilage cannot be recognised by conventional X ray films: authors show the interest of high frequency ultra sonography when the trauma is known, finding a localised tumefaction, sometimes a rib cartilage fracture. When the traumatism in unknown, ultra sonography can correct the diagnosis.
Article
To determine the mortality, hospital and intensive care unit (ICU) stay of rib fractures in patients admitted to Victorian hospitals for more than 1 day. All patients fitting the entry criteria for the Victorian Major Trauma Study with fractured ribs were identified between 1 March 1992 and 28 February 1993. Aetiology, age, sex, associated injury and outcome were analysed. Patients with rib fractures had a higher mortality and length of hospital stay, but this was not significantly different from other trauma. A significantly higher percentage of patients required ICU care for rib fractures (44%) compared with the total group with blunt injury (24%). The majority of rib fractures resulted from motor vehicle accidents 361/541 (67%). Injuries occurring on the street/highway resulting in rib fractures were more likely to be major; 62% had Injury Severity Score (ISS) > 15. Fractured ribs occurred more commonly with increased age. Mortality for patients with fractured ribs versus total trauma group was higher in elderly patients. Univariate analysis showed rib fractures were a positive predictor of death but when adjusted for ISS and age, rib fractures became a negative predictor. Rib fractures were not predictors for length of ICU or hospital stay. The sample of rib fractures collected in this study underestimates the overall incidence. For those patients admitted to hospital with identified rib fractures, there is a trend towards higher mortality and morbidity. However, this association is better predicted by ISS and age.
Article
The medical and social impact of chest trauma is immense (1). Chest injuries directly cause 25% of all trauma-related deaths and contribute markedly to another 25% (2,3). Sadly, many of these injuries affect young, otherwise healthy individuals. Even more sadly, since motor vehicle accidents cause most major chest trauma (4-7), many of these injuries could be prevented by the routine use of seat belts and by strict enforcement of speed limits and drunk driving laws. This article is not an all-inclusive catalog of thoracic injuries. Many excellent books (2,4,8-10) and articles (5-7,11- 15) have already been written that provide a broad, sweeping overview of chest trauma. I have instead decided to review the biomechanical, clinical, and radiologic features of a relatively small number of thoracic injuries chosen either because of their profound effect on patient morbidity and mortality and/or because of the peculiar diagnostic difficulties they present to radiologists and clinicians alike. Strategies for avoiding the diagnostic pitfalls associated with these entities are presented, and the advantages and disadvantages of available imaging studies are discussed.
Article
Chest wall trauma and rib fractures are significant sources of morbidity and mortality in countries in which motor vehicle accidents are prevalent. Physicians who care for injured patients should realize that patients with thoracic trauma are at significant risk for mortality, deterioration, and associated injuries. Care must be taken to avoid underestimation of the effect of the injury on subsequent respiratory mechanics. Armed with an understanding of chest injury epidemiology, biomechanics, and pain control, physicians can better serve these high-risk patients.
Article
The fact that ultrasound (US) waves are reflected completely by the bony thorax and are erased from the aerated lung to a large extent led to the mistaken notion that sonography is not a very useful diagnostic tool for use in this region. On the other hand, since the beginning of US imaging, reports have been published regularly on pleuropulmonary sonographic diagnostic and therapeutic procedures. Rib fractures could be detected about twice as often by US than x-ray. With regard to determining the nodal status in neoplastic disease of the axilla and supraclavicular fossa, US is superior to palpation. In imaging pleural effusions, US is more accurate than chest film and is useful in determining the nature of the pleural effusion. Sonographic evidence of pleural nodules is a specific finding in patients with a malignant effusion. Chest sonography is a useful diagnostic tool for critically ill patients with chest diseases. Performed at the bedside, this technique can be particularly helpful when computed tomography is not available or when critically ill patients cannot be moved.
Article
Conventional frontal radiography is mandatory in trauma patients and usually sufficient to detect rib fractures, even though the alignment of bone fragments or projection difficulties may sometimes hinder their depiction. Therefore, there exists moderate disagreement between clinically suspected rib fractures and radiographic findings. We report our personal experience with US in the detection of rib conditions (fractures and bruises), missed at preliminary radiography. Five symptomatic patients with suspected rib fractures underwent radiographic and US studies. All patients were examined with a real time unit (RT 2800, GE Medical Systems, Milwaukee, USA) with a 7.5 MHz linear probe. US demonstrated rib fractures in 4 patients with negative radiographic findings and a parosteal hematoma in one patient. We conclude that US can detect the rib fractures missed at conventional radiography and show rib cartilage conditions, costochondral dislocations and parosteal hematomas. Therefore we suggest the routine use of this technique in all chest trauma patients, as a useful complement to frontal radiographs, for both management and forensic purposes.
Article
Objective: We describe the CT and sonographic appearance of 15 costal cartilage fractures observed in eight patients. Conclusion: On CT, fracture was seen as a low-density area through the costal cartilage, with surrounding calcifications present near old fractures, and gas density within the cleft in some cases. On sonography, cartilage fracture appeared as an interruption of the smooth anterior aspect of the cartilage.
Article
Transthoracic ultrasound (US) of the chest is useful in the evaluation of a wide range of peripheral parenchymal, pleural, and chest wall diseases. Furthermore, it is increasingly used to guide interventional procedures of the chest and pleural space. The technique lends itself to bedside use in the intensive care unit, where suboptimal radiography may mask or mimic clinically significant abnormalities. The authors discuss the uses, techniques and applications of US of the chest. The sonographic appearances of pleural diseases (pleural effusion, pneumothorax, pleural mass, and mesothelioma), parenchymal diseases (pneumonia, neoplasms, heart failure, infarct, and rounded atelectasis), chest wall abnormalities (chest wall tumor and rib fracture), and diaphragmatic paralysis are discussed. The use of US in guiding biopsy, thoracocentesis, and other interventional procedures of the lung, pleural space, and mediastinum are also reviewed.
Article
To describe the management, morbidity and mortality seen with isolated rib fractures in elderly patients and assess the need for hospitalization. A case series. A tertiary care centre in Tel Aviv. Hospital records of 77 elderly patients (age 65 yr and older) admitted with isolated rib fractures were reviewed over a 9-year period. Main outcome measures: Demographic, medical and hospitalization data, blood hemoglobin and oxygen saturation levels. The number of fractured ribs was found to correlate with the morbidity (p = 0.027) and mortality (p = 0.006). There were no significant differences in these rates with respect to comorbidity except for diabetes (higher morbidity) and congestive heart failure (higher mortality). Twenty-eight patients (36%) had pulmonary complications and 1 had cardiac complications. Pulmonary complications were fatal in 6 patients (7.8%). Multivariate analysis of the factors related to morbidity demonstrated that only oxygen saturation (p = 0.0009) and diabetes (p = 0.03) correlated significantly. In spite of significant morbidity and mortality in elderly patients with isolated rib fractures, prediction of the prognosis for these patients is presently not possible. Admission for observation and treatment is therefore justified and beneficial.
Article
Rib fractures (RFs) are estimated to be present in 10 per cent of all traumatic injuries. However, up to 50 per cent of all fractures go undetected on the screening chest X-ray (CXR). The purpose of this study was to identify the incidence of clinical (CRFs) and objective rib fractures (ORFs) as well as to examine the utility of the routine follow-up CXR with regard to patient recovery and healthcare cost. We identified patients sustaining RF in addition to other traumatic injuries with an Injury Severity Score (ISS) < or = 15 and RF as the primary pathology. Five hundred fifty-two patients sustained blunt thoracic trauma with resultant RF. Two hundred nine patients had RFs and an ISS < or = 15. The average ISS was 8. Follow-up films illustrated that 93 per cent of CRFs had resolution of any pathology, 4 per cent had persistent X-ray findings, and 4 per cent were lost to follow-up. Ultimately 93 per cent of patients with CRF were able to resume daily activities without disability and 3 per cent incurred lifestyle changes at home or work, which was significantly better than those with ORFs (P < 0.05). Follow-up films produced no change in clinical management and cost approximately $2000/year. The prognosis for CRFs is excellent if treatment consists of appropriate pain management and pulmonary rehabilitation. We do not advocate routine follow-up CXRs in addition to physical examination for the evaluation of CRFs unless clinical deterioration is evident.
Article
To determine the usefulness of ultrasound in the detection of rib fractures. A prospective study was performed over a 3-month period. Patients presenting with a high clinical suspicion of rib fracture(s) to the Accident and Emergency Department were referred for radiological work-up with a PA chest radiograph, an oblique rib view and a chest ultrasound. Associated lesions, e.g. pleural effusion, splenic laceration and pneumothorax were recorded. Fourteen patients were radiologically assessed. The mean patient age was 31 years (range 16-55 years) and the M:F ratio 3.7:1 (11 men and 3 women). Ten patients displayed a total of 15 broken ribs. Chest radiography detected 11, oblique rib views 13 and ultrasound 14 broken ribs. Ultrasound findings included discontinuity of cortical alignment in 12 fractures, an acoustic linear edge shadow in nine and a reverberation artifact in six. Concordance with plain film findings, and especially oblique rib views, was good, though better when the rib fractures fragments were markedly displaced. One splenic laceration was detected with an associated small pleural effusion. There were no pneumothoraces. The average time of ultrasound examination was 13 min. Ultrasound does not significantly increase the detection rate of rib fractures, may be uncomfortable for the patient and is too time-consuming to justify its routine use to detect rib fractures.