Cough-induced costal cartilage fracture

Daniels, Steven P.; Kazam, J. Jacob; Yao, Katherine V.; Xu, Helen S.; Green, Daniel B.

doi:10.1016/j.clinimag.2019.03.007

Cited by 7 publications

(4 citation statements)

References 20 publications

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“…After a brief literature review, we found that the most well described mechanism of injury that approaches vomiting is vigorous coughing. According to a recent study, costal cartilage fracture due to violent coughing was reported in two cases [2]. In our case, recurrent vomiting induced a costal cartilage fracture.…”

Section: Discussionmentioning

confidence: 45%

“…Costal cartilage fractures should be considered, especially in cases of blunt trauma involving contact sports athletes or high-energy trauma, such as motor vehicle accidents [1]. These fractures are often underdiagnosed, while atraumatic cases have rarely been reported in the literature [2]. In this article, a case of vomiting-induced costal cartilage fracture is presented.…”

Section: Introductionmentioning

confidence: 97%

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Vomiting-induced costal cartilage fracture: a case report

et al. 2022

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The use of ultrasonography as a first line imaging test in cases of possible costal cartilage fracture can be pivotal. In this case report, we present the case of a patient with a suspected atraumatic vomiting-induced costal cartilage fracture. The costal cartilage fracture was non-displaced and incomplete, thus not visible in a Computed Tomography scan. When Ultrasound imaging was employed at the area of tenderness, soft tissue edema and hematoma around the cartilage were visualized. High level of suspicion for a cartilage fracture in this case revealed a subtle osseous injury.

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Section: Discussionmentioning

confidence: 45%

Section: Introductionmentioning

confidence: 97%

Vomiting-induced costal cartilage fracture: a case report

et al. 2022

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“…[ 18 ] Even costal cartilage fracture may occur due to this mechanism. [ 19 ] The second mechanism is thought to be linked with contrary muscle forces acting on the ribs. Opposing action of intercostal muscles and other respiratory muscles on the same rib may weaken it, leading to fracture.…”

Section: Discussionmentioning

confidence: 99%

Cough-induced rib fractures: A comprehensive analysis of 90 patients in a single center

Oğuzhan Özyurtkan,

Arslan Ulukan,

Temel

2024

Turk Gogus Kalp Dama

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Background: This study aims to evaluate clinical and radiological characteristics of the patients with cough-induced rib fractures. Methods: Between January 2008 and December 2022, a total of 90 patients (35 males, 55 females; mean age: 58±20 years; range, 20 to 92 years) who had cough-induced rib fractures were retrospectively analyzed. Patients' characteristics, findings of physical and radiological examination, and patients’ outcomes were recorded. Results: Of the patients, 64% were postmenopausal, 37% had metabolic disease of the bone, and 21% had chronic cough. Cough etiology was acute upper respiratory tract infection (32%), followed by chronic obstructive pulmonary disease. Thoracic computed tomography documented 154 fractures. Cough-induced rib fractures were mostly on the right side (58%). Multiple fractures were more commonly seen in older patients (p=0.007), in the presence of novel coronavirus disease-2019 (COVID-19) pneumonia (p=0.03), and metabolic disease of the bone (p=0.01). Mostly the sixth rib was affected (23%). Most fractures (81.3%) affected the fourth to ninth ribs. Most fractures developed on the anterolateral aspect of the rib (51%). The mean duration of hospital stay was 5.0±1.6 days. Morbidity developed in one patient (1.1%) (hemothorax). Mortality occurred in two patients (2.2%) due to COVID-19 pneumonia and acute myocardial infarction. Conclusion: Localized pain after cough should be investigated in terms of cough-induced rib fractures. Cough-induced rib fractures are mostly seen in the presence of acute upper respiratory tract infection, chronic obstructive pulmonary disease, and pneumonia. Postmenopausal women are more risky to develop cough-induced rib fractures. Multiple cough-induced rib fractures are common in the presence of metabolic disease of the bone, older age, COVID-19 pneumonia.

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“…The location of CCF is mainly determined by the focus of traumatic stress, which can be non-calcified or calcified costal cartilage (15). Atraumatic CCF mostly develops in the high brittle part of the costal cartilage (16). Non-calcified costal cartilage commonly has good elasticity and toughness.…”

Section: Discussionmentioning

confidence: 99%

The Value of 99mTc-Methylene Diphosphonate Single-Photon Emission Computed Tomography/Computed Tomography in Detecting Atraumatic Costal Cartilage Fracture in Malignant Tumor Patients

Zhang

et al. 2020

Front. Oncol.

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Objectives: To assess the clinical significance and single-photon emission computed tomography/computed tomography (SPECT/CT) features of atraumatic costal cartilage fracture (CCF) in patients with malignant tumors.Methods: This was a retrospective review of 38 tumor patients with atraumatic CCF referred to SPECT/CT, who were served as the study group (SG). The features of SPECT/CT of atraumatic CCF were assessed. Another 100 tumor patients who underwent chest SPECT/CT and did not have CCF were randomly selected as the control group (CG). In all patients (SG + CG), the diagnostic powers in the detection of atraumatic CCF were computed among CT, SPECT, and SPECT/CT. The final diagnosis was based on pathological findings and radiologic follow-up of at least 1 year.Results: On SPECT/CT images of atraumatic CCF in the SG, fracture lines, irregular calcification, deformation, and swelling were, respectively, noted in 26.3, 47.4, 34.2, and 18.4% of lesions; low, moderate, and high uptake were, respectively, noted in 13.2, 52.6, and 34.2% of lesions. In all patients (SG + CG), the diagnostic powers in the detection of atraumatic CCF of CT, SPECT, and SPECT/CT were as follows: sensitivity 63.2, 100.0, and 92.1%; specificity 86.0, 81.0, and 94.0%; negative predictive value 86.0, 100.0, and 96.9%; positive predictive value 63.1, 66.7, and 85.4%; and area under the curve value 0.746, 0.905, and 0.931.Conclusions: Atraumatic CCF has certain characteristic appearances on SPECT/CT. It should be enrolled in the differential diagnoses when costal cartilages of patients with malignant tumors show abnormal elevated 99m Tc-MDP uptake on scintigraphy. Single-photon emission computed tomography/CT has excellent diagnostic power in detecting atraumatic CCF.

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Cough-induced costal cartilage fracture

Cited by 7 publications

References 20 publications

Vomiting-induced costal cartilage fracture: a case report

Vomiting-induced costal cartilage fracture: a case report

Cough-induced rib fractures: A comprehensive analysis of 90 patients in a single center

The Value of 99mTc-Methylene Diphosphonate Single-Photon Emission Computed Tomography/Computed Tomography in Detecting Atraumatic Costal Cartilage Fracture in Malignant Tumor Patients

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