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Costal Cartilage Fractures as Revealed on CT and Sonography

¹ All authors: Department of Radiology, University of Louvain, St. Luc University Hospital, Hippocrate Ave., 10, B-1200 Brussels, Belgium.

View larger version (71K): [in a new window]   Fig. 1. —Drawing shows location of costal cartilage fractures. Two main sites are chondrosternal and chondrocostal junctions of first rib and middle part of cartilages of second to eighth ribs.

View larger version (57K): [in a new window]   Fig. 2A. —26-year-old man with multiple rib fractures after motor vehicle collision. CT scan reveals interruption (arrows) with break in continuity of third costal cartilage. Patient also had multiple other bony rib and costal cartilage fractures (not shown).

View larger version (124K): [in a new window]   Fig. 3A. —28-year-old man with painful left parasternal lump for 6 months. Patient reported no traumatic history but was drug addict and engaged in contact sports. Bone scan shows discrete area of increased uptake in left parasternal area (arrow) at level of lump, and several other intense foci in extremities of subjacent ribs corresponding to fractures.

View larger version (55K): [in a new window]   Fig. 3B. —28-year-old man with painful left parasternal lump for 6 months. Patient reported no traumatic history but was drug addict and engaged in contact sports. Transverse CT (B) and sagittal oblique multiplanar reformatted CT (C) scans perpendicular to costal cartilage of left sixth rib show heterogeneous focal swelling, with peripheral calcifications.

View larger version (105K): [in a new window]   Fig. 3C. —28-year-old man with painful left parasternal lump for 6 months. Patient reported no traumatic history but was drug addict and engaged in contact sports. Transverse CT (B) and sagittal oblique multiplanar reformatted CT (C) scans perpendicular to costal cartilage of left sixth rib show heterogeneous focal swelling, with peripheral calcifications.

View larger version (54K): [in a new window]   Fig. 3D. —28-year-old man with painful left parasternal lump for 6 months. Patient reported no traumatic history but was drug addict and engaged in contact sports. Curved frontal multiplanar reformatted (D) and maximum-intensity-projection (E) images from sets of CT slices of anterior chest wall show that focal hypodensity and peripheral calcifications correspond to transverse area perpendicular to costal cartilage.

View larger version (51K): [in a new window]   Fig. 3E. —28-year-old man with painful left parasternal lump for 6 months. Patient reported no traumatic history but was drug addict and engaged in contact sports. Curved frontal multiplanar reformatted (D) and maximum-intensity-projection (E) images from sets of CT slices of anterior chest wall show that focal hypodensity and peripheral calcifications correspond to transverse area perpendicular to costal cartilage.

View larger version (98K): [in a new window]   Fig. 4A. —46-year-old man with history of overlooked thoracic trauma that occurred 3 months earlier during stay in intensive care unit. CT scans show swelling of soft tissue surrounding irregular costal cartilage with focal interruptions (thick arrow, A) and typical fracture angulations (thick arrow, B). Note peripheral calcifications (thin arrows).

View larger version (99K): [in a new window]   Fig. 4B. —46-year-old man with history of overlooked thoracic trauma that occurred 3 months earlier during stay in intensive care unit. CT scans show swelling of soft tissue surrounding irregular costal cartilage with focal interruptions (thick arrow, A) and typical fracture angulations (thick arrow, B). Note peripheral calcifications (thin arrows).

View larger version (85K): [in a new window]   Fig. 5A. —19-year-old man who experienced sudden onset of left parasternal pain during gymnastic training on parallel bars. S = sternum. CT scan shows thin band of gas density (thick arrow) within gap between cartilage of first left rib (thin arrow) and sternum.

View larger version (157K): [in a new window]   Fig. 2B. —26-year-old man with multiple rib fractures after motor vehicle collision. Sonogram of third rib shows interruption and displacement of hyperechogenic line, corresponding to ventral aspect of costal cartilage (arrows).

View larger version (86K): [in a new window]   Fig. 5B. —19-year-old man who experienced sudden onset of left parasternal pain during gymnastic training on parallel bars. S = sternum. Sonogram (dual image) of same region as A shows small hyperechogenic area (thick arrow) corresponding to gas accumulation between hypoechogenic cartilage (thin arrow) and hyperechogenic line delineating anterior aspect of sternum.

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