Stove-in chest

A stove-in chest is a rare and complex type of flail chest injury where the flail segment collapses into the chest. It is usually due to severe blunt trauma to the chest wall and is rarely encountered in imaging or emergency medicine due to the high mortality at the scene. It may evolve over days or weeks from a traumatic flail chest.

A case report in 2004 described the development of a stove-in chest in a patient with a flail chest injury after insertion of an intercostal catheter for management of a pneumothorax which reversed with ventilatory support ¹.

Radiographic features

Chest radiography and CT will show multiple rib fractures and a flail segment with an internal displacement of the ribs reducing the volume of the lung.

As with flail chest, the stove-in chest is almost always associated with other thoracic injuries including:

• pulmonary contusion and/or laceration
• pneumothorax and subcutaneous emphysema
• hemothorax

Treatment and prognosis

There is significant controversy in the optimum management of trauma patients with flail chest, ranging from conservative management to surgical rib plate fixation. The overall goals are adequate pain relief, optimization of gas exchange (pneumatic stabilization with positive airway pressure and/or ventilation), and the prevention of secondary sepsis ^1,2.

Stove-in chest has a very high mortality.

History and etymology

Stove is the past participle of stave, which means to break something inwards with force.