Presentation
Fall from height onto chest.
Patient Data
This case featured in our 2016 Trauma Radiology Course which is now available to view online.
Comminuted right clavicular shaft fracture. Multiple right rib fractures laterally. Right 5th rib fracture posteriorly. No definite hemothorax or pneumothorax seen. Mediastinal contour is probably normal for a supine projection.
Right 3rd to 6th rib, right 7th transverse process and right 8th to 9th rib fractures posteriorly about the costotransverse joints. The right 4th to 8th ribs are also fractured laterally. This produces a significant flail segment despite a relatively innocuous looking initial chest x-ray. Comminuted right clavicular shaft fracture. Right basal intercostal catheter insitu with residual small to moderate volume right hemothorax, right lower lobe collapse / consolidation likely due to pulmonary hemorrhage and patchy lung contusion elsewhere. Trace left pleural fluid.
10 days later the patient remained in hospital with the flail segment now easily visible due to increased displacement. The right lower lobe remains collapsed.
Case Discussion
This case demonstrates how seemingly minor rib fractures on an initial trauma chest x-ray can actually be part of a significant flail segment when investigated with CT. Internal fixation of ribs was not initially performed in this patient and unfortunately substantial displacement of the flail segment and persistent lower lobe collapse occurred.