What is the role of rib radiographs in the evaluation of rib fractures?

Updated: Jun 13, 2017
  • Author: Sarah L Melendez, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Answer

Obtaining a rib radiograph series remains controversial, as the additional information rarely changes the clinical picture or alters treatment. Rib detail radiographs can be helpful in evaluation of the 1st and 2nd ribs and the 7th through 12th ribs. (See the images below.) Formal plain radiographs can also be useful to document abuse for legal purposes.

Anteroposterior (AP) radiograph of an elderly fema Anteroposterior (AP) radiograph of an elderly female patient with severe left chest wall pain after a minor fall. This image demonstrates a left lateral rib fracture (arrow) that is not seen on the standard AP chest radiograph.
Right rib radiograph in a 48-year-old male who pre Right rib radiograph in a 48-year-old male who presented with severe right posterior chest wall pain following a fall. This image demonstrates 2 fractures of the right chest wall (white arrows).

Diagnostic sensitivity is higher in rib radiographs than in chest radiographs; however, with a high clinical suspicion, treat for fracture regardless of the radiographic result.

Aortic injury, as shown in the image below, is closely associated with a widening of greater than 8 cm measured at the widest points of the mediastinum on an upright anteroposterior chest radiograph.

Aortic injury is closely associated with a widenin Aortic injury is closely associated with a widening of greater than 8 cm measured at the widest points of the mediastinum on an upright anteroposterior chest radiograph.

Clinicians should obtain a skeletal survey in infants suspected of being abused. Findings consistent with abuse include the presence of multiple rib fractures in various stages of healing.


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