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Slipping rib syndrome (SRS) is an underdiagnosed condition that can lead to debilitating lower chest and upper abdominal pain (Am J Med Sci 2019; 357: 168). It is caused by hypermobility of the anterior ends of the costal cartilages of false ribs, allowing the eighth to tenth ribs to slip under the rib above, giving its name (Semin Pediatr Surg 2018; 27: 183). Failure to recognize this syndrome can expose patients to extensive and unnecessary investigations for unclear symptoms. Although more commonly reported in adults, SRS is a relatively uncommon but recognized cause of lower chest or upper abdomen pain in adolescence (Pediatr Anesth 2001; 11: 740). It is important for clinicians to familiarize themselves with and consider the diagnosis of SRS when assessing and managing adolescents with persistent thoracic pain. We present a case of a 14-year-old girl with unresolved thoracic pain for more than 4 years and was ultimately diagnosed with SRS.

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Introduction: Early diagnosis and treatment of intestinal volvulus are important to reduce morbidity. A fluoroscopic upper GI study is the gold standard for diagnosis and may be performed in a secondary or tertiary care centre prior to surgery. It is important the reporting radiologist is confident in the findings. We aim to assess whether there is any difference in confidence and study quality between paediatric and general radiologists who work in secondary or tertiary care centres. Methods: Retrospective review of initial radiology reports and blinded review of the study images by paediatric radiologists. Results: A total of 277 children underwent a fluoroscopic study for intestinal volvulus over a four-year period. The majority were performed at a tertiary care centre, by paediatric radiologists. The confidence of initial reporting was higher in paediatric than general radiologists despite whether they worked in a secondary or tertiary care centre (P-value < 0.001). On retrospective review, studies performed by paediatric radiologists were rated as having a higher confidence in identifying the location of the duodenojejunal flexure. General radiologists tended to have a slightly higher rate of repeat studies but still low at 2.2%. Despite this, there was no significant difference in the diagnosis rates and secondary centre general radiologists excluded malrotation in 62% of studies likely reducing transfer rates. Conclusion: Confidence in initial reporting and on review of the duodenojejunal flexure location in suspected intestinal volvulus is higher in paediatric radiologists compared with general radiologists, although diagnosis rates are no different.

Pathologist who identified emphysema as a danger to miners Bob Ryder laid the foundation for compensation for ex-coal miners and coal miners' widows by showing that emphysema was directly caused by working in coal mines.