Normal ribs series

Case contributed by Amanda Er
Diagnosis certain

Presentation

Low-risk road traffic accident with complaints of neck pain and tenderness of right lower ribs.

Patient Data

Age: 60 years
Gender: Female
x-ray

The heart size is normal with no consolidation, pneumothorax or pleural effusion seen. No displaced rib fracture is detected as well.

The anatomy of left anterior oblique chest is shown below:

  1. head of the right rib

  2. neck of the right rib

  3. tubercle of the right rib

  4. angle of the right rib

  5. body of the right rib

  6. right coastal cartilage (calcified)

  7. right hemidiaphragm

  8. sternum

  9. trachea

  10. carina

  11. right main bronchus

  12. left main bronchus

  13. left hemidiaphragm

  14. costodiaphragmatic recess

Case Discussion

This case is an example of a normal ribs series comprising the PA chest and oblique ribs views, which are part of the ribs fracture protocol in the department that this patient presented at. The patient was in a left anterior oblique (LAO) position, hence allowing elongation and better visualization of the right ribs laterally.

A frontal (PA or AP) ribs projection may also be requested depending on departments. This projection applies a lower kV higher mAs technique to highlight bony structures and is hence unlike a standard chest radiograph.

It is important to note that in some parts of the world, e.g. the United Kingdom, it is against best practice to perform a rib series for uncomplicated rib fractures as diagnosing them does not change patient management 1.

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