Ultrasound also has the advantage of being a dynamic examination that can detect abnormal movement at the fracture site 11.Ĭonfusion of the pleural surface with rib cortex Signs of a cartilage fracture include a fracture line, disruption of the anterior echogenic margin, a step-off deformity, or gas located at the costochondral junction 2,3. Furthermore, it may be helpful to perform an ultrasound examination when there is a high clinical suspicion, with or without a mass, and other modalities have not demonstrated an injury 3. Ultrasound can be used reliably to diagnose costal cartilage fractures and can increase the sensitivity of their detection when used together with CT scanning 5,6. Unlike CT it does not involve ionizing radiation and is, therefore, preferable in a pediatric population and for follow-up examinations 1,7. Due to their low incidence, they may also be easily overlooked on additional imaging. wrestling 10), the lower ribs can suffer costal cartilage fracturing more easily 1 and are more likely to fracture due to direct trauma 10.ĭisruptions or fractures of costal cartilage may result in an unstable rib cage potentially exposing thoracic contents, such as the heart, to injury 1.įractures of the costal cartilage are challenging to establish on physical examination and are not visible on plain radiographs unless there is severe calcification of the cartilage 3,4. PathologyĬostal cartilage can fracture due to blunt trauma sustained in high-energy trauma or a fall. While the more immobile first and second ribs seem to be more prone to costochondral separation from twisting injuries (e.g.
In older patients, pain is the primary complaint 1,2 which can present months after the trauma 11. In young children, a costal cartilage fracture can present as a chest wall mass associated with pain (differentials include neoplasm and post-traumatic hematoma). They can be associated with some contact sports such as hockey, wrestling, and American football 10.
Most reported cases are in males and result from blunt trauma, fall or motor vehicle collision 1,2,11.
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