Chest Radiology > Pathology > Trauma

Trauma - Rib fracture

Rib fractures have the appearance of an abrupt discontinuity in the smooth outline of the rib.  A lucent fracture line may be seen.  A rib fracture may not be visible on a CXR.  CXR is taken to assess for pneumothorax, but it may show them.  If it is necessary to exclude a rib fracture, oblique rib detail films should be obtained.

A common pattern for evaluating the ribs is to examine the posterior portions of the ribs first, then the anterior portions, and finish be examining the lateral aspects of each rib.  If you see an abnormality, follow that rib in its entirety. 

Fracture of the upper three ribs is associated with an increased risk of aortic injury because of the excessive force needed to fracture these ribs.  Fracture of the lower three ribs can be associated with liver or spleen injury.  Multiple bilateral rib fractures in various stages of healing are associated with child abuse in children or alcohol abuse.

 

PA and Lateral exams of right ninth rib fracture.  No PTX was present. 

 

CT from the same patient in the PA and lateral films above.  
This clearly shows the rib displacement near the liver on the right.

 

This PA exam shows a left flail chest, or multiple rib fractures, that can now move paradoxically with the rest of the thoracic cage.

 

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