Thoracic wall trauma—misdiagnosed lesions on radiographs and usefulness of ultrasound, multidetector computed tomography and magnetic resonance imaging

Tomás, Xavier; Facenda, Catherine; Vaz, Nuno; Castañeda, Edgar Augusto; Amo, Montserrat del; García-Diez, Ana Isabel; Pomés, Jaime

doi:10.21037/qims.2017.08.02

Cited by 11 publications

(19 citation statements)

References 40 publications

(52 reference statements)

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“…Chest radiography has shown limited efficacy with low sensitivity for chest wall lesions and often does not correlate with clinical symptoms [5,6,7,8]. In contrast, bone scintigraphy with Tc-99m diphosphonates has been performed in patients with atypical chest pain to identify occult chest wall lesions such as rib fractures or bone metastasis, not detected by radiography [9].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Value of Bone SPECT/CT Using 99mTc-Methylene Diphosphonate in Patients with Unspecified Chest Wall Pain

et al. 2021

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Purpose We investigated the diagnostic performance of single photon emission computed tomography (SPECT)/computed tomography (CT) as a combination of functional and anatomic imaging, in patients with unspecified chest wall pain. Methods Fifty-two patients with unspecified chest wall pain and no history of recent major traumatic events or cardiac disease were included. The number and location of radioactive chest wall lesions were evaluated on both planar images and SPECT/CT. The clinical diagnosis was made based on all of the clinical and imaging data and follow-up information. Results Chest wall diseases were diagnosed in 42 patients (80.8 %). SPECT/CT showed abnormal findings in 35 (67.3 %) patients with positive predictive value (PPV) of 97.1 %. SPECT/CT revealed 56 % more lesions than planar bone scan (P = 0.002) and most of the abnormal radioactive lesions (94.6 %) showed combined morphological changes on the matched CT component. When comparing between age subgroups (< 60 y vs. ≥ 60 y), the prevalence of chest wall disease and diagnosis rate of fracture was significantly higher in the older age group. On SPECT/CT, the older age group showed higher frequency of having abnormal finding (95.8 % vs. 42.9 %, P < 0.001) and significantly more lesions were detected (a total of 189 vs. 32, P = 0.003). Conclusion SPECT/CT showed good diagnostic performance and proved to have higher sensitivity, detecting 56 % more lesions than planar bone scan. A negative result could be helpful for excluding pathologic chest wall disease. SPECT/CT might be recommended for integration in to the diagnostic workup in patients with unspecified chest wall pain, especially in patients ≥ 60 y of age, considering the high disease prevalence and the high frequency of positive results.

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Section: Introductionmentioning

confidence: 99%

Diagnostic Value of Bone SPECT/CT Using 99mTc-Methylene Diphosphonate in Patients with Unspecified Chest Wall Pain

et al. 2021

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“…Even though the usefulness of CT in diagnosing costal cartilage fractures is well established [7] the same is not true for MRI. There are some reports comparing findings between diagnostic modalities [8], but are of limited value, due to the small number of cases they examine. The same is true for the role of US [9].…”

Section: Discussionmentioning

confidence: 99%

Vomiting-induced costal cartilage fracture: a case report

et al. 2022

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The use of ultrasonography as a first line imaging test in cases of possible costal cartilage fracture can be pivotal. In this case report, we present the case of a patient with a suspected atraumatic vomiting-induced costal cartilage fracture. The costal cartilage fracture was non-displaced and incomplete, thus not visible in a Computed Tomography scan. When Ultrasound imaging was employed at the area of tenderness, soft tissue edema and hematoma around the cartilage were visualized. High level of suspicion for a cartilage fracture in this case revealed a subtle osseous injury.

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“…Radiologists do have similar taxonomy for rib fractures in their literature (nondisplaced, minimally displaced, severely displaced, etc. ) 28–30 ; however, there does not seem to be as definitive descriptive terminology applied (example, severely displaced fracture is ≥50% displacement of the total bone width/height) as there is in the trauma/surgical literature. Although SSRF is now becoming more accepted as a treatment modality for patients with rib fractures worldwide, there still exists controversy over the indications of its use 18,31 .…”

Section: Discussionmentioning

confidence: 99%

Discrepancies in rib fracture severity between radiologist and surgeon: A retrospective review

Bauman

Binkley²,

Pieper³

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Chest computed tomography (CT) scans are important for the management of rib fracture patients, especially when determining indications for surgical stabilization of rib fractures (SSRFs). Chest CTs describe the number, patterns, and severity of rib fracture displacement, driving patient management and SSRF indications. Literature is scarce comparing radiologist versus surgeon rib fracture description. We hypothesize there is significant discrepancy between how radiologists and surgeons describe rib fractures. METHODS:This was an institutional review board-approved, retrospective study conducted at a Level I academic center from December 2016 to December 2017. Adult patients (≥18 years of age) suffering rib fractures with a CT chest where included. Basic demographics were obtained. Outcomes included the difference between radiologist versus surgeon description of rib fractures and differences in the number of fractures identified. Rib fracture description was based on current literature: 1, nondisplaced; 2, minimally displaced (<50% rib width); 3, severely displaced (≥50% rib width); 4, bicortically displaced; 5, other. Descriptive analysis was used for demographics and paired t test for statistical analysis. Significance was set at p = 0.05. RESULTS:Four hundred and ten patients and 2,337 rib fractures were analyzed. Average age was 55.6(±20.6); 70.5% were male; median Injury Severity Score was 16 (interquartile range, 9-22) and chest Abbreviated Injury Scale score was 3 (interquartile range, 3-3). For all descriptive categories, radiologists consistently underappreciated the severity of rib fracture displacement compared with surgeon assessment and severity of displacement was not mentioned for 35% of rib fractures. The mean score provided by the radiologist was 1.58 (±0.63) versus 1.78 (±0.51) by the surgeon (p < 0.001). Radiologists missed 138 (5.9%) rib fractures on initial CT. The sensitivity of the radiologist to identify a severely displaced rib fracture was 54.9% with specificity of 79.9%. CONCLUSION:Discrepancy exists between radiologist and surgeon regarding rib fracture description on chest CT as radiologists routinely underappreciate fracture severity. Surgeons need to evaluate CT scans themselves to appropriately decide management strategies and SSRF indications.

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Thoracic wall trauma—misdiagnosed lesions on radiographs and usefulness of ultrasound, multidetector computed tomography and magnetic resonance imaging

Cited by 11 publications

References 40 publications

Diagnostic Value of Bone SPECT/CT Using 99mTc-Methylene Diphosphonate in Patients with Unspecified Chest Wall Pain

Diagnostic Value of Bone SPECT/CT Using 99mTc-Methylene Diphosphonate in Patients with Unspecified Chest Wall Pain

Vomiting-induced costal cartilage fracture: a case report

Discrepancies in rib fracture severity between radiologist and surgeon: A retrospective review

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