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MRI Evaluation of Costal Cartilage Injuries

Naveen Subhas1, Mitchell J. Kline2, Michael J. Moskal3, Lawrence M. White4 and Michael P. Recht1

1 Imaging Institute, Cleveland Clinic, 9500 Euclid Ave., A21, Cleveland, OH 44195.
2 Department of Musculoskeletal Radiology, University of Louisville, New Albany, IN.
3 Department of Orthopedic Surgery, Shoulder & Elbow Center, PSC, New Albany, IN.
4 Department of Medical Imaging, Mount Sinai Hospital and the University Health Network, University of Toronto, Toronto, ON, Canada.


Figure 1
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  		Fig. 1 —Schematic of costal cartilages shows location of injuries in our study population. Numbers indicate number of injuries at each location. (Courtesy of Cleveland Clinic Foundation)

 

Figure 2
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  		Fig. 2A —50-year-old man with chest wall pain after injury sustained when heavy object fell on his chest. Coronal STIR (A) and coronal gradient-echo (B) images show linear high signal (arrow) in left first costal cartilage near sternochondral junction corresponding to nondisplaced fracture line. Increased signal compatible with edema is also seen in adjacent soft tissues.

 

Figure 3
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  		Fig. 2B —50-year-old man with chest wall pain after injury sustained when heavy object fell on his chest. Coronal STIR (A) and coronal gradient-echo (B) images show linear high signal (arrow) in left first costal cartilage near sternochondral junction corresponding to nondisplaced fracture line. Increased signal compatible with edema is also seen in adjacent soft tissues.

 

Figure 4
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  		Fig. 3 —21-year-old manwith chest wall pain after rugby injury. Coronal STIR image shows high signal at first costal cartilage near sternochondral junction (white arrow), compatible with fracture. Note small triangular fragment (arrowheads) of first costal cartilage that still remains attached to sternum. High signal is also seen at left sternoclavicular junction (black arrow), compatible with associated sternoclavicular injury.

 

Figure 5
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  		Fig. 4A —17-year-old boy with persistent chest wall pain after wrestling injury. Axial CT image shows subtle nondisplaced fracture (arrows) that was initially missed.

 

Figure 6
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  		Fig. 4B —17-year-old boy with persistent chest wall pain after wrestling injury. Injury is more apparent on fat-suppressed T2-weighted coronal MR image because of high signal (arrow) at site of injury. C = clavicle, S = sternum.

 

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