Abdominal CT: rib fractures

Diagnosing rib fractures

The lower ribs are included in an abdominal CT. Injury to these ribs is commonly associated with liver or splenic injury and pneumothorax. It is very helpful to ask the trauma team where the injury and pain are so that careful attention can be directed to that area.

Evaluate all ribs

Using bone windows, you can see discontinuity of the cortex, which is the hard, outer layer of bone, indicating a fracture. Rib fractures usually occur in multiples, so a complete evaluation of all ribs is performed when interpreting the chest CT.

Abdominal CT rib fractures 1
Discontinuity of cortex
Use both sagittal and axial images

Sagittal and axial images can be helpful in seeing several sequential rib fractures as they often occur adjacent to each other due to the traumatic forces applied.

Abdominal CT rib fractures
Rib fractures

In the example below of sequential rib fractures on axial images, there is increasing displacement of the fractures starting with a small cortical defect with slight angulation in the upper rib, followed by a visible line and progressing toward over-riding ribs as they displace.

Abdominal CT rib fractures axial
Axial images

Remember that rib fractures can be subtle! You should carefully perform your evaluation of the lower ribs in multiple planes.

This is an edited excerpt from the Medmastery course Abdomen CT: Trauma by Michael P. Hartung, MD. Acknowledgement and attribution to Medmastery for providing course transcripts


Radiology Library: Abdominal Trauma. Musculoskeletal injuries

Abdominal CT interpretation

Assistant Professor of Abdominal Imaging and Intervention at the University of Wisconsin Madison School of Medicine and Public Health. Interests include resident and medical student education, incorporating the latest technology for teaching radiology. I am also active as a volunteer teleradiologist for hospitals in Peru and Kenya. | Medmastery | Radiopaedia | Website | Twitter | LinkedIn | Scopus 

Dr Adam Brown LITFL Author

MBChB (hons), BMedSci - University of Edinburgh. Living the good life in emergency medicine down under. Interested in medical imaging and physiology. Love hiking, cycling and the great outdoors.

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