Clinical History 54-year-old woman with left upper chest pain and focal swelling for 10 days, beginning while straining to lift a heavy object and exacerbated during subsequent yoga session when she felt a popping sensation.
Ultrasound of the Month – Case 191
1
Imaging in the transverse plane to the rib along the anterior left upper chest where patient indicates focal symptoms reveals cortical disruption (arrow) of one of the ribs (arrowheads indicate the echogenic superficial cortex of the rib) next to the costochondral junction (CC denotes the adjacent costal cartilage).
Ultrasound of the Month – Case 191
2
Imaging in the transverse plane to the rib (R) at the fracture site shows surrounding rim of hypoechoic soft tissue (arrowheads) with associated mild power doppler hyperemia.
Ultrasound of the Month – Case 191
3
Cine clip of the rib with gentle probe pressure on the more lateral portion of the rib shows mobility between the rib components at the fracture site, in keeping with acuity.
Ultrasound of the Month – Case 191
4
Diagnosis: Acute Rib Fracture As ribs are superficial boney structures, ultrasound is a useful and sensitive tool for the diagnosis of rib fractures. Acute rib fracture is seen on ultrasound as a disruption in the echogenic line of the rib cortex, while a more subacute fracture may show surrounding callus formation. However, ultrasound cannot demonstrate a stress reaction that has not progressed to a discrete fracture – this requires MRI to show intraosseous marrow edema. An advantage of sonography is the ability to target imaging very focally and directly to the location of the patient’s pain.
Ultrasound of the Month – Case 191
5