Sono of the Week: Rib Fracture

• Images provided by Dr. Aherne
• Writers: Team Sono / Ultrasound Fellows Drs. Hanuscin and Lee
• Edited by: Dr. Murphy

Case Background:

An elderly male presented to the ED with left-sided chest pain after a mechanical fall one week prior. He did not complain of shortness of breath and only came to the ED because his wife made him. Bedside ultrasound demonstrated a rib fracture, good lung sliding, and a small left-sided pleural effusion. Findings were confirmed with chest x-ray. 

POCUS:

Lung sliding on left:

LUQ view:

Learning Points:

1. Use linear probe to scan the affected rib in transverse and longitudinal views over the maximal point of tenderness 

2. Lung ultrasound may be superior to chest radiography, but the low quality of the evidence precludes ant definitive statement (PMID: 30470688)

3. Ultrasound can also be used to rule in or rule out a pneumothorax associated with a rib fracture (PMID: 21868468)

Resources:

1. How to assess for rib fractures using ultrasound 

2. Consider a Serratus Anterior Nerve Block or Erector Spinae Block for pain control 

3. More images of Rib Fractures on ultrasound: Pocus Atlas: Rib Fractures 

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Marie J Murphy, MD MPH

PGY-3 in Emergency Medicine at SUNY Downstate Medical Center/Kings County Hospital Center. Webmaster for Clinical Monster and County EM Blog. Co-leader for Health Policy and Informatics Mini Fellowship with an interest in Clinical Health Informatics.

Latest posts by Marie J Murphy, MD MPH (see all)

• Not Too FAST: Which RUQ view is positive for free fluid? - May 24, 2022
• Sono of the Week: Rib Fracture - March 18, 2022
• Ultrasonography of Cardiac Tamponade - December 18, 2021