Ultrasound Case 020

Presentation

A 27 year old male presents after a motor vehicle accident, He has focal tenderness over his sternum which is worse with movement and deep inspiration.

Ultrasound excludes large pneumothorax but you wonder whether you can see a sternal fracture.

Longitudinal view sternum

Describe and interpret these scans

IMAGE INTERPRETATION

Image 1: Longitudinal view sternum; The linear transducer is placed in sagittal section over the sternum. Sliding it from the sternal notch to the xiphisternum shows the manubrium, then the sterno-manubrial junction (a cartilaginous joint) and then the sternum.

A transverse fracture is seen just proximal to the point the third costal cartilage joins the sternum. The proximal and distal sternum move relative to one another with inspiration, proving the fracture involves both cortices.


CLINICAL CORRELATION

Sternal fracture.

In adults the sterno-manubrial junction at the level of the second costal cartilage is clearly identified with ultrasound and should not be confused with a fracture. In children there are numerous ossification centres in the sternum and these should not be confused with fractures (sternebrae). Congenital abnormalities of the sternum (such as a “bullet hole“) can also cause confusion.

Patients with an isolated sternal fracture are usually able to precisely localize their worst pain. Scan at this point and search for a clear lack of continuity in the anterior sternal cortex that runs transversely. You often see a small associated hypoechoic haematoma. Where the two parts of the sternum move separately with respiration it can be inferred the fracture involves both cortical surfaces.


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An Emergency physician based in Perth, Western Australia. Professionally my passion lies in integrating advanced diagnostic and procedural ultrasound into clinical assessment and management of the undifferentiated patient. Sharing hard fought knowledge with innovative educational techniques to ensure knowledge translation and dissemination is my goal. Family, wild coastlines, native forests, and tinkering in the shed fills the rest of my contented time. | SonoCPDUltrasound library | Top 100 | @thesonocave |

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