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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Ultrasound in revelation
of chondral rib fracture and bony rib
fracture at an outpatient clinic : A
Vietnamese experience
Le Thanh Liem,
Nguyen Thien Hung, Le van Tai, Lu Minh Tan, Le Tu Phuc, Phan Thanh Hai
MEDIC MEDICAL CENTER, HCMC, Vietnam
Abstract:
OBJECTIVE:
To disclose chondral
or bony rib fracture by ultrasound which are negative on X-ray film of minor
blunt chest trauma patients.
METHODS:
A total of 42
patients suffering from minor blunt chest trauma without evidence of a rib fracture on chest X-ray film, were examined with a 9L4 MHz
or 7.5 MHz linear transducer of ultrasound system (Siemens, Aloka). Statistical
analysis was done to outline the ultrasound findings of these rib fractures.
RESULTS:
There were 50 (100.0%)
patients showed chondral and bony rib lesions, whereas these 50 patients had no
evidence of rib lesions on X-ray film. Fracture of
the rib with a disruption of continuity of bony cortex near junction of chrondral and bony rib was the most common
finding in 45 (90,0%) patients. Chondral rib fractures
were in five (10,0% )patients. Chondral rib fracture appeared as disruption of
cortex, small echogenic lines in chondral rib, and bruised chondral rib was a
small deformation of chondral cortex and echogenic area at trauma site which
was painful site. Bony rib fractures significantly occurred in trauma patients, and
the duration of pain in patients with chondral rib fractures
was significantly longer than that of patients with bony rib fractures.
CONCLUSIONS:
Ultrasonography
is a useful imaging method in disclosing the rib fractures
(chondral and bony rib fractures) which were negative
on chest X-ray film in minor blunt chest trauma. However, chondral rib fractures significantly occur less than bony rib
fractures and result in a longer duration of pain.
Chondral rib fracture by ox kicking for 4 days.
2 cases of bruised chondral rib by hitting with echogenic line.
A case of calcified chondral rib for 4 years by beating.
A bruised of chondral rib with echogenic area in costal cartilage (below image), but ARFI velocity value in out of range (above image).
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Tại MEDIC, trong 6 tháng cuối năm 2012, có 5 ca gãy dập sụn sườn trong số 50 ca chấn thương nhẹ lồng ngực với gãy xương sườn (và thân xương ức). Ca gãy sụn sườn gần với lúc khám siêu âm là 4 ngày do bị bò đá, ca xa nhất, 4 năm. X-quang không thấy tổn thương ở 2 ca này và các ca còn lại (45
ca). Gãy xương sườn là tổn thương không liên tục của vỏ xương, thường gần chỗ nối sụn và xương, và có kèm theo máu tụ khu trú thành ngực quanh ổ gãy. Gãy sụn sườn ít gặp hơn với đường viền sụn gián đoạn, hay các đường echo dày trong sụn sườn, trong khi dập sụn sườn có các vùng echo dày trong sụn và bao sụn biến dạng lỏm ở nơi va chạm.
Siêu âm phần mềm thành ngực là phương tiện khám có hiệu quả và phát hiện sớm các trường hợp gãy sụn sườn, xương sườn (và xương ức), góp phần chẩn đoán đầy đủ các trường hợp chấn thương ngực kín nghi có tổn thương xương và sụn sườn, mà các phương tiện khác như X-quang và CT có thể bỏ sót.
