Ultrasound Case 034

Presentation

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.

View 2: Left 6th rib at the anterior axillary line
View 3: Left second interspace midclavicular line

Describe and interpret these scans

IMAGE INTERPRETATION

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.


CLINICAL CORRELATION

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.


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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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