A 22 year old man is brought in by ambulance after a rugby injury – he was sandwiched between two players. He is complaining of left lower anterolateral chest pain worse with inspiration.
Describe and interpret these scans
Image 1: Left costal margin at the midclavicular line. There is a step at the usually continuous costochondral junction. This is costochondral separation.
Image 2: Left 6th rib at the anterior axillary line. More laterally a rib fracture is seen. As the transducer slides into the interspace below the costophrenic angle with lung and diaphragm demonstrated. A very small amount of pleural fluid is seen in the angle.
Image 3: Left second interspace midclavicular line. There is no pneumothorax. There is movement at the pleural line and at least one comet tail artifact is seen confirming apposition. The sliding is slightly reduced as the patient is not breathing deeply.
Image 4: Another view of the costochondral separation.
Ultrasound rapidly demonstrates chest wall trauma. Scan over the site of pain and follow the ribs in longitudinal section searching for lack of continuity in the cortex.
Large pneumothorax can be rapidly excluded as can significant haemothorax. Underlying lung disease makes this more difficult.