US case of the the month Rib fracture see on ultrasound and not on X-ray

1. Ultrasound Case of the Month
42 y/o female with right anterior
chest wall pain

2. Metallic markers placed over anterior chest wall at site of pain.
No abnormality was detected on the initial radiographs.

3. Figures A and B. Long axis images of the costochondral junction of the right anterior second and third
ribs. (A) Red arrow depicts cortical discontinuity along the second rib at the costochondral junction (yellow
arrows demonstrate the hyaline cartilage). (B) A normal costo-chondral junction is seen at the third rib
(green arrow- rib cortex; yellow arrows- cartilage).
The rib appears as a bright reflector with posterior shadowing. A wavy echogenic line
below the cartilage represents the pleural surface (blue arrows). The rib and adjacent cartilage should
appear as a continuous line.
A. B.

4. Figure C. Transverse view through the 2nd costochondral junction. A small
hypo-echoic gap ( red arrow) is present in the rib, corresponding to the non-displaced
fracture. This should normally be smooth and continuous. There is dense shadowing deep to
the rib. The linear white line deep to the rib relates to the pleural edge (blue arrows).

5. Diagnosis: Costochondral
junction fracture, right second
anterior rib
Ultrasound provides a sensitive
method to detect radiographically
occult rib and cartilage fractures.
References:
1. Griffith et al. Sonography compared with radiography in revealing acute rib fractures. AJR
1999; 173: 1603-0.
2. Turk et al. Evaluation by ultrasound of traumatic rib fractures missed by radiography. Emerg
Radiol 2010; 17: 473-7.