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High-Resolution Sonography of the Rib: Can Fracture and Metastasis Be Differentiated?

Sang Hyun Paik1, Myung Jin Chung2, Jai Soung Park1, Jin Mo Goo3 and Jung-Gi Im3

1 Department of Radiology, Soonchunhyang University, Bucheon Hospital, Gyeonggido, Korea.
2 Department of Radiology and Imaging Science, Sungkyunkwan University School od Medicine, Samsung Medical Center, 50 Ilwon-dong, Kangnam-gu, Seoul 135–710, Korea.
3 Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.



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  		Fig. 1A. —47-year-old man with lung cancer and confirmed rib metastasis. Bone scintigram shows active uptake at right fourth rib (arrow).

 


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  		Fig. 1B. —47-year-old man with lung cancer and confirmed rib metastasis. Radiograph shows mass formation and blurring of inferior rib margin (arrow).

 


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  		Fig. 1C. —47-year-old man with lung cancer and confirmed rib metastasis. Sonogram shows bone destruction and mass formation (arrows).

 


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  		Fig. 1D. —47-year-old man with lung cancer and confirmed rib metastasis. Power Doppler sonogram shows increased intratumoral blood flow.

 


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  		Fig. 2A. —43-year-old man with trauma 10 days previously and confirmed traumatic rib fracture. Bone scintigram shows focal hot uptake at anterior arch of fourth–seventh ribs (arrows).

 


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  		Fig. 2B. —43-year-old man with trauma 10 days previously and confirmed traumatic rib fracture. Radiograph shows cortical disruption with soft-tissue swelling (arrows).

 


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  		Fig. 2C. —43-year-old man with trauma 10 days previously and confirmed traumatic rib fracture. Sonogram shows cortical disruption (arrow) and hematoma formation (arrowheads) on transverse and longitudinal scans.

 


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  		Fig. 3A. —61-year-old woman with breast cancer and acute right chest pain. Bone scintigram shows increased uptake of radionuclide on right, at seventh rib (arrow).

 


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  		Fig. 3B. —61-year-old woman with breast cancer and acute right chest pain. Radiograph cannot show rib lesion (arrow), despite magnification.

 


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  		Fig. 3C. —61-year-old woman with breast cancer and acute right chest pain. Sonogram shows cortical disruption (arrow) with subtle hematoma formation at 1 cm proximal to costochondral junction (arrowhead) on panoramic view.

 


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  		Fig. 3D. —61-year-old woman with breast cancer and acute right chest pain. Bone window setting of axial CT scan obtained 6 months after C shows subtle sclerosis and angulation at costochondral junction of right seventh rib, at which rib fracture was suspected (solid arrow), compared with contralateral costochondral junction (open arrow). At close observation, hot-uptake rib lesion on bone scintigraphy was confirmed to be incidental rib fracture.

 


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  		Fig. 4A. —43-year-old man with colon cancer and multiple bone metastases. Bone scintigram shows multiple increased uptake of radionuclide at ribs and skull.

 


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  		Fig. 4B. —43-year-old man with colon cancer and multiple bone metastases. Radiograph shows multiple osteolytic lesions at rib cage.

 


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  		Fig. 4C. —43-year-old man with colon cancer and multiple bone metastases. On rib sonogram, no lesion is visualized. When metastatic lesion involves only bone marrow, bone cortex can be intact. Sonography cannot transmit through intact bony cortex. Thus, if there are multiple increased uptakes of radionuclide on scintigraphy and negative results on rib sonography, metastatic lesion is suggested.

 

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