CT Chest As described above, chest CT is more sensitive than radiography for the detection of rib fractures after CPR. Moreover, CT may show fracture-related complications that are radiographically occult. Kim et al [33] reported that CT found fracture-related complications in 6 of 40 patients (15%) who received CPR, including 1 pneumothorax, 1 subclavian vein injury, and 4 chest wall hematomas. This study did not indicate whether intravenous (IV) contrast was used, nor did it indicate whether CT was performed specifically for evaluation of rib fractures, or if the rib fractures were an incidental finding on a CT performed for other means (eg, suspected pulmonary embolism). Variant 3: Suspected pathologic rib fracture. Initial imaging. Radiography Chest Pathologic fractures may result from metabolic disorders or neoplasm, including primary bone tumor, metastatic disease of intrathoracic or extrathoracic primary, hematologic malignancy (eg, multiple myeloma, lymphoma), or direct extension of a tumor in the thorax. A PA chest radiograph may be sufficient for diagnosis of a pathologic fracture (or provide clues to an underlying diagnosis), but further evaluation using such modalities as CT, bone scan, or FDG-PET may be necessary to further characterize a lesion detected on radiography or to search for radiographically occult lesions [36-38]. Radiography Rib Views There is no strong indication in the literature that radiography rib series serves any significant use as an initial imaging modality to detect suspected pathologic rib fractures. US Chest There is no strong indication in the literature that US serves any significant use as an initial imaging modality to detect rib fractures. CT Chest CT may be useful for characterizing a pathologic fracture, and some features may be helpful in differentiating a primary malignant tumor of bone from metastasis [36].
Rib Fractures. CT Chest As described above, chest CT is more sensitive than radiography for the detection of rib fractures after CPR. Moreover, CT may show fracture-related complications that are radiographically occult. Kim et al [33] reported that CT found fracture-related complications in 6 of 40 patients (15%) who received CPR, including 1 pneumothorax, 1 subclavian vein injury, and 4 chest wall hematomas. This study did not indicate whether intravenous (IV) contrast was used, nor did it indicate whether CT was performed specifically for evaluation of rib fractures, or if the rib fractures were an incidental finding on a CT performed for other means (eg, suspected pulmonary embolism). Variant 3: Suspected pathologic rib fracture. Initial imaging. Radiography Chest Pathologic fractures may result from metabolic disorders or neoplasm, including primary bone tumor, metastatic disease of intrathoracic or extrathoracic primary, hematologic malignancy (eg, multiple myeloma, lymphoma), or direct extension of a tumor in the thorax. A PA chest radiograph may be sufficient for diagnosis of a pathologic fracture (or provide clues to an underlying diagnosis), but further evaluation using such modalities as CT, bone scan, or FDG-PET may be necessary to further characterize a lesion detected on radiography or to search for radiographically occult lesions [36-38]. Radiography Rib Views There is no strong indication in the literature that radiography rib series serves any significant use as an initial imaging modality to detect suspected pathologic rib fractures. US Chest There is no strong indication in the literature that US serves any significant use as an initial imaging modality to detect rib fractures. CT Chest CT may be useful for characterizing a pathologic fracture, and some features may be helpful in differentiating a primary malignant tumor of bone from metastasis [36].