Simple X-ray versus ultrasonography examination in blunt chest trauma: effective tools of accurate diagnosis and considerations for rib fractures

Abstract

Simple radiography is the best diagnostic tool for rib fractures caused by chest trauma, but it has some limitations. Thus, other tools are also being used. The aims of this study were to investigate the effectiveness of ultrasonography (US) for identifying rib fractures and to identify influencing factors of its effectiveness. Between October 2003 and August 2007, 201 patients with blunt chest trauma were available to undergo chest radiographic and US examinations for diagnosis of rib fractures. The two modalities were compared in terms of effectiveness based on simple radiographic readings and US examination results. We also investigated the factors that influenced the effectiveness of US examination. Rib fractures were detected on radiography in 69 patients (34.3%) but not in 132 patients. Rib fractures were diagnosed by using US examination in 160 patients (84.6%). Of the 132 patients who showed no rib fractures on radiography, 92 showed rib fractures on US. Among the 69 patients of rib fracture detected on radiography, 33 had additional rib fractures detected on US. Of the patients, 76 (37.8%) had identical radiographic and US results, and 125 (62.2%) had fractures detected on US that were previously undetected on radiography or additional fractures detected on US. Age, duration until US examination, and fracture location were not significant influencing factors. However, in the group without detected fractures on radiography, US showed a more significant effectiveness than in the group with detected fractures on radiography (P=0.003). US examination could detect unnoticed rib fractures on simple radiography. US examination is especially more effective in the group without detected fractures on radiography. More attention should be paid to patients with chest trauma who have no detected fractures on radiography.

When will pulmonary function recover after rib fracture?

“…Rib fracture is the most common form of chest injury that may result from falls, automobile accidents, or assaults. A simple chest posteroanterior and rib series is usually a sufficient diagnostic tool (Hurley et al, 2004); however, other methods like computed tomography and ultrasound sonography are occasionally used to verify the diagnosis (Hwang and Lee, 2016). The primary treatment goal for rib fracture is pain relief.…”

Ultrasound in the diagnosis of rib fracture following blunt chest trauma: a case study

“…Failed detection rates have been demonstrated to be in the vicinity of 30% to 50% and because of this the true incidence of rib fracture still remains unknown . Disclosure of rib fractures with plain film radiography is limited unless there is a definite displacement or an obvious step‐off noted at the fracture site, and costal cartilage fractures cannot be convincingly detected unless there is sufficient ossification at the region of injury . The technicalities of obtaining a projection can also compromise rib fracture diagnosis considering that fractures cannot be detected at certain respiratory intervals or at particular angles of X‐ray projection .…”

“…Although CT of the chest was not used in this case study, it has been suggested that its limitations in the evaluation of rib fracture include a low specificity in the setting of a higher radiation dose . A reason for this lower specificity involves its inability to examine each rib parallel to its long axis but using both axial and coronal images has shown to improve the overall detection rate of rib fracture .…”

“…Unfortunately, this ideology is compounded when the limitations of conventional imaging modalities are evaluated. In the acute setting, plain radiography can render rib fractures undetected in 50% of cases, and although computer tomography (CT) is deemed to have a higher sensitivity than plain film, its limitations can include a lower specificity in the setting of higher radiation doses . Regarded as being a sentinel injury, a rib fracture can act as an external marker to more serious pathologies which can in turn compromise the normal breathing mechanism and/or the status of the thoraco‐abdominal organs.…”

Is ultrasonography helpful in minor trauma patients with rib fractures?

“…Rib fractures are clinically suspected in the presence of the related history of the patient, coughing, and localization of the pain with palpation and deep breathing [2]. Unfortunately, there are several limitations on the chest x-ray [4,5]. Costal cartilage fractures could be radiologically overlooked unless the densely calcified cartilage is broken [4].…”