FDG-PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT as initial imaging in the evaluation of chest wall pain in patients with no history of malignancy. MRI Chest MRI may be complementary to other modalities in characterization of various processes and to delineate the extent of chest wall or osseous involvement on a case-by-case basis [15]. Radiography Chest After a thorough history and physical examination, chest radiography may be a useful initial imaging test to evaluate for specific etiologies of chest wall pain (eg, rib fracture, infection, or neoplasm) and to evaluate for other conditions that may simulate chest wall pain, such as spontaneous pneumothorax [16]. However, chest radiographs may be insensitive to detect abnormalities of the rib cartilages, costochondral junctions, costovertebral joints, and chest wall soft tissues. In a series of 183 stable adult outpatients presenting with nontraumatic chest pain imaging with both chest radiography and rib series, rib fractures were detected in only 4.9% of cases [17]. In another study of 1,089 patients presenting to the emergency department who underwent chest radiography for evaluation of nontraumatic chest pain, only 70 (6.4%) were deemed to have findings clinically relevant to emergency department care [18]. In one series of patients with rupture of the costal margin associated with severe coughing fits, all patients had widening of the rib spaces on chest radiographs, whereas 4/9 patients had associated rib fractures [19]. Nontraumatic Chest Wall Pain US Chest Although diagnostic ultrasound (US) of the chest is not typically utilized for the evaluation of chest wall pain, point- of-care US has been shown to be feasible for detection of rib fractures in the setting of minor trauma in emergency settings, with 27/94 (29%) detecting rib fractures after negative chest radiography [22].
Nontraumatic Chest Wall Pain. FDG-PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT as initial imaging in the evaluation of chest wall pain in patients with no history of malignancy. MRI Chest MRI may be complementary to other modalities in characterization of various processes and to delineate the extent of chest wall or osseous involvement on a case-by-case basis [15]. Radiography Chest After a thorough history and physical examination, chest radiography may be a useful initial imaging test to evaluate for specific etiologies of chest wall pain (eg, rib fracture, infection, or neoplasm) and to evaluate for other conditions that may simulate chest wall pain, such as spontaneous pneumothorax [16]. However, chest radiographs may be insensitive to detect abnormalities of the rib cartilages, costochondral junctions, costovertebral joints, and chest wall soft tissues. In a series of 183 stable adult outpatients presenting with nontraumatic chest pain imaging with both chest radiography and rib series, rib fractures were detected in only 4.9% of cases [17]. In another study of 1,089 patients presenting to the emergency department who underwent chest radiography for evaluation of nontraumatic chest pain, only 70 (6.4%) were deemed to have findings clinically relevant to emergency department care [18]. In one series of patients with rupture of the costal margin associated with severe coughing fits, all patients had widening of the rib spaces on chest radiographs, whereas 4/9 patients had associated rib fractures [19]. Nontraumatic Chest Wall Pain US Chest Although diagnostic ultrasound (US) of the chest is not typically utilized for the evaluation of chest wall pain, point- of-care US has been shown to be feasible for detection of rib fractures in the setting of minor trauma in emergency settings, with 27/94 (29%) detecting rib fractures after negative chest radiography [22].