A 8 years old child was brought to radiology department for X-ray chest following an accidental fall from the roof top.
His X ray is shown below:
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X- Ray Description: X-ray chest (AP view of chest) shows 3rd to 8th rib fractures (white arrows) on left side, each at two places with encysted hemothorax (black arrow) and lung contusion (extends between the asterisks) with mediastinal pushed to the right side.
Diagnosis: Flail chest.
Clinical Discussion:
Flail chest is a critical condition following major blunt chest trauma in which two or more
contiguous ribs are fractured at two or more places. In this condition, a segment of the thoracic cage is separated from the rest of the chest (flail segment), as a result a part of the chest wall moves freely in the opposite direction as to the rest of the chest.
The related complications are :
Diagnosis: CT is superior to chest radiograph for most thoracic injuries. It can demonstrate pulmonary contusion, lacerations, pneumothorax and hemothorax that may be missed on plain radiographs. Spiral CT with high resolution image acquisition followed by sagittal and coronal
reconstructions clearly depict spinal and diaphragmatic injuries if associated.
Treatment includes alteration of position to make the patient most comfortable and provide relief of pain, good analgesia with intercostal block and positive pressure ventilation. Surgical fixation is usually not required.
His X ray is shown below:
X- Ray Description: X-ray chest (AP view of chest) shows 3rd to 8th rib fractures (white arrows) on left side, each at two places with encysted hemothorax (black arrow) and lung contusion (extends between the asterisks) with mediastinal pushed to the right side.
Diagnosis: Flail chest.
Clinical Discussion:
Flail chest is a critical condition following major blunt chest trauma in which two or more
contiguous ribs are fractured at two or more places. In this condition, a segment of the thoracic cage is separated from the rest of the chest (flail segment), as a result a part of the chest wall moves freely in the opposite direction as to the rest of the chest.
The related complications are :
- pneumothorax,
- pleural effusion,
- pulmonary laceration and
- contusion.
Diagnosis: CT is superior to chest radiograph for most thoracic injuries. It can demonstrate pulmonary contusion, lacerations, pneumothorax and hemothorax that may be missed on plain radiographs. Spiral CT with high resolution image acquisition followed by sagittal and coronal
reconstructions clearly depict spinal and diaphragmatic injuries if associated.
Treatment includes alteration of position to make the patient most comfortable and provide relief of pain, good analgesia with intercostal block and positive pressure ventilation. Surgical fixation is usually not required.