Presentation
Fall down stairs.
Patient Data
Increased opacity of the left hemithorax compared to the right is suspicious for pleural effusion/hemothorax. Multiple displaced rib fractures on the left.
The cardiomediastinal contours are unremarkable allowing the limitations of this projection. No pneumothorax or subdiaphragmatic free gas.
Multiple rib fractures:
- Anterior undisplaced third rib
- Posterior and anterior undisplaced fourth rib
- Posterior undisplaced and anterior mildly displaced fifth rib
- Displaced posterior and undisplaced anterior sixth rib
- Displaced posterior and mildly displaced anterior sixth rib
- Displaced posterior and undisplaced anterior seventh rib
- Severely displaced neck and displaced posterior eighth rib
- Comminuted and displaced head and undisplaced posterior ninth rib
- Undisplaced posterior tenth rib
Moderate to large hemothorax. No pneumothorax. No subcutaneous emphysema.
Left T4 to T10 transverse process fractures.
An intercostal catheter has been inserted with reduced veiling opacity of the left hemithorax. Left chest wall subcutaneous emphysema. The right lung and pleural space are clear. Multiple left rib fractures again demonstrated. Internal fixation left proximal humerus.
Case Discussion
Rib fractures are often thought of as benign injuries but as this case demonstrates when multiple they can be serious and are often associated with further injuries such as hemothorax and other fractures. The initial chest x-ray demonstrates multiple rib fractures but underestimates the true extent of the injury as well as only hinting at the moderate sized hemothorax present.
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