UMEM Educational Pearls

Title: What's the Diagnosis? Case by Dr. Thuy Pham and Dr. Stephen Shaheen

Posted: 12/23/2013 by Haney Mallemat, MD
Click here to contact Haney Mallemat, MD

Question

Patient with a history of osteogenesis imperfecta presents with right lateral chest pain following a sneeze. The ultrasound of his chest is shown (hint: arrow points to a rib). What's the diagnosis?

Answer

Rib fracture

Rib fractures may be missed on traditional diagnostics such as chest X-ray.
Ultrasound can be used to not only detect rib fractures but more importantly to detect co-existing injury such as pneumothorax or pulmonary contusion.
The ultrasound exam is easy and fast to perform:
- The linear probe is used to evaluate
- Ask the patient to place the probe on the point of maximal tenderness.
- Evaluate the bright cortex of the bone in either cross-section or longitudinal plane (as is shown in case)
Look for other pathologies (e.g., pneumothorax) if rib fracture is discovered
Watch this video for a demonstration of the technique http://vimeo.com/1086731

References

Turk F. et al. Evaluation by ultrasound of traumatic rib fractures missed by radiography. Emerg Radiol. 2010 Nov;17(6):473-7. doi: 10.1007/s10140-010-0892-9

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