Another study showed US to detect costochondral fractures in 68.8% of radiographically occult cases [23]. US of the chest has several diagnostic limitations, including technical difficulties related to posterior location of fractures, and soft-tissue penetration in patients with large breasts [22]. Patient-reported pain during the US examination limited evaluation in only 14% of cases but may be helpful in targeting the examination to the focal abnormality. US has added benefits of dynamic imaging capabilities as well as relative ease [15,24]. Dynamic US detected slipping rib syndrome in 32/36 (89%) and ruled it out in 10/10 (100%) [25]. WBC Scan Chest There is no relevant literature to support the use of nuclear medicine white blood cell (WBC) chest scans as initial imaging in the evaluation of chest wall pain in patients with no history of malignancy. Variant 2: Nontraumatic chest wall pain. Known or suspected malignancy. Secondary evaluation after normal chest radiograph. Next imaging study. Bone Scan Whole Body Bone scintigraphy has been shown to have 95% sensitivity for detection of skeletal metastases and defines extent of involvement across the entire skeleton [26]. It may have a role in characterization of primary chest wall neoplasms, especially those that may contain chondroid or osteoid components [26]. Limitations of bone scintigraphy occur in the setting of nonosteoblastic processes such as multiple myeloma that may not be detected by this modality. Although uncommon, chest wall metastases usually indicate advanced disease. Osseous metastases may manifest as sclerotic (eg, prostate cancer), mixed lytic and sclerotic (eg, breast cancer), or purely lytic (eg, renal cell carcinoma) and are best characterized at CT [27]. Soft-tissue metastases may be readily detected at CT if they involve the skin or subcutaneous fat.
Nontraumatic Chest Wall Pain. Another study showed US to detect costochondral fractures in 68.8% of radiographically occult cases [23]. US of the chest has several diagnostic limitations, including technical difficulties related to posterior location of fractures, and soft-tissue penetration in patients with large breasts [22]. Patient-reported pain during the US examination limited evaluation in only 14% of cases but may be helpful in targeting the examination to the focal abnormality. US has added benefits of dynamic imaging capabilities as well as relative ease [15,24]. Dynamic US detected slipping rib syndrome in 32/36 (89%) and ruled it out in 10/10 (100%) [25]. WBC Scan Chest There is no relevant literature to support the use of nuclear medicine white blood cell (WBC) chest scans as initial imaging in the evaluation of chest wall pain in patients with no history of malignancy. Variant 2: Nontraumatic chest wall pain. Known or suspected malignancy. Secondary evaluation after normal chest radiograph. Next imaging study. Bone Scan Whole Body Bone scintigraphy has been shown to have 95% sensitivity for detection of skeletal metastases and defines extent of involvement across the entire skeleton [26]. It may have a role in characterization of primary chest wall neoplasms, especially those that may contain chondroid or osteoid components [26]. Limitations of bone scintigraphy occur in the setting of nonosteoblastic processes such as multiple myeloma that may not be detected by this modality. Although uncommon, chest wall metastases usually indicate advanced disease. Osseous metastases may manifest as sclerotic (eg, prostate cancer), mixed lytic and sclerotic (eg, breast cancer), or purely lytic (eg, renal cell carcinoma) and are best characterized at CT [27]. Soft-tissue metastases may be readily detected at CT if they involve the skin or subcutaneous fat.