What is the role of chest CT scan in the evaluation of rib fracture?

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

Chest CT scan (see the image below) is more sensitive than plain radiographs for detecting rib fractures. [7] The modality can also provide information regarding the number of ribs involved.

Axial computed tomography image of the chest in a Axial computed tomography image of the chest in a patient with both anterior and posterior thoracic injuries. A fracture of the sternum (white arrow) and a posterior left rib fracture (yellow arrow) are present.

If complications from rib fractures are suspected clinically or diagnosed by plain radiographs, a chest CT scan may be helpful to document specific injuries, to characterize extent of injury, and to plan for definitive management.

An associated CT scan of the abdomen with intravenous contrast should be considered in cases involving lower rib fractures with suspected or known injury to the liver and/or the spleen. The reported incidence of concomitant intra-abdominal injuries with lower rib fractures is 20-40%. Abdominal CT has been reported to be particularly important if patients are younger than 55 years, have bilateral rib fractures, and have decreased hematocrit levels. [38]

In a study of rib fractures in clinically diagnosed cases of child abuse, a retrospective analysis of initial and follow-up skeletal surveys and CT scans of 16 patients younger than 12 months found that 17% (18 of 105) of rib fractures were not documented on the initial skeletal survey. Those fractures not originally detected were seen only after follow-up imaging, more than half of which (11/18) were detected on a subsequent CT. Many of these were posterior (43%) or anterior (30%), and 96% were nondisplaced. [39]


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