Multiple rib fractures and incidental asbestosis in a trauma patient
Presentation
This 75 year old male was driven over by a tractor. A CT trauma series was performed.
Patient Data
- Pleural thickening and calcification related to prior trauma or asbestos exposure
- Multiple rib fractures demonstrated bilaterally
- Loculated left pneumothorax
Case Discussion
Asbestos related disease results from inhaled exposure to asbestos fibers. They are a group of naturally occurring silicates.
Manifestations of asbestos-related disease include1:
- Benign pleural disease - CT findings include pleural effusions, pleural plaques and diffuse pleural thickening
- Asbestosis - CT findings may include subpleural curvilinear opacities, ground-glass opacification, subpleural nodular opacities, honeycombing and thickening of interlobular septa
- Malignant mesothelioma - CT findings may include smooth or lobular thickening of the pleura
In this patient, bilateral thickening of the pleura is strongly suggestive of exposure to asbestos. This patient had a history of extensive asbestos handling during his middle aged years.
In regards to rib fractures, the 4th to 9th ribs are most commonly fractured. Superior rib fractures of the 1st to 3rd ribs are more commonly associated with subclavian vasculature and brachial plexus injury. More inferior rib fractures of the 10th to 12th ribs are associated with visceral injury, in particular, the spleen, kidney and liver2,3. In general, the greater the number of fractured ribs, the more severe the causative injury.
Rib fractures can have multiple complications. These include:
- Pneumothorax
- Hemothorax
- Pulmonary contusions
- Flail chest
- Pneumonia
- Atelectasis
Case contributed by A/Prof. Pramit Phal.