We present two cases of atraumatic costal cartilage fracture secondary to violent coughing. Although costal cartilage fractures due to trauma and bony rib fractures due to violent coughing have been described, to our knowledge there have been no prior reported cases of cough-induced costal cartilage fracture. It is important for radiologists to consider costal cartilage fractures, which are often more subtle than osseous injuries, in patients with chest pain, and understand that they may not always be preceded by direct trauma. Identifying this injury is clinically important and will prevent patients from undergoing unnecessary examinations to rule out a cardiac cause of chest pain or a pulmonary embolism.
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- A national study of the prevalence of life-threatening diagnoses in patients with chest pain.JAMA Intern Med. 2016; 176: 1029-1032
Leite L, Baptista R, Leitão J, Cochicho J, Breda F, Elvas L, et al. Chest pain in the emergency department: risk stratification with Manchester triage system and HEART score. BMC Cardiovasc Disord 2015; 15: 48. doi:https://doi.org/10.1186/s12872-015-0049-6.
- Musculoskeletal chest wall pain.Can Med Assoc J. 1985; 133: 379-389
- Rib fractures induced by coughing: an unusual cause of acute chest pain.Am J Emerg Med. 2000; 18: 194-197
- Diaphragmatic rupture: a complication of violent cough.Chest. 2000; 117: 1200-1201https://doi.org/10.1378/chest.117.4.1200
- Cough-induced internal oblique hematoma.J Emerg Trauma Shock. 2013; 6: 132-134https://doi.org/10.4103/0974-2700.110789
- Costal cartilage fractures and disruptions in a rugby football player.Clin J Sport Med. 2013; 23: 232-234https://doi.org/10.1097/JSM.0b013e31825b55ed
- MRI evaluation of costal cartilage injuries.Am J Roentgenol. 2008; 191: 129-132https://doi.org/10.2214/AJR.07.3396
- Incidence and imaging findings of costal cartilage fractures in patients with blunt chest trauma: a retrospective review of 1461 consecutive whole-body CT examinations for trauma.Radiology. 2018; 286: 696-704https://doi.org/10.1148/radiol.2017162429
- Chondral rib fractures in professional American football: two cases and current practice patterns among NFL team physicians.Orthop J Sport Med. 2016; 4: 1-5https://doi.org/10.1177/2325967115627623
- Spontaneous rib fractures.Asian Cardiovasc Thorac Ann. 2015; 23: 701-703https://doi.org/10.1177/0218492315586485
- Cough-induced rib fracture and diaphragmatic rupture resulting in simultaneous abdominal visceral herniation into the left hemithorax and subcutaneously.Eur J Cardio-Thoracic Surg. 2008; 34: 914-915https://doi.org/10.1016/j.ejcts.2008.06.048
- Cough-induced rib fractures.Mayo Clin Proc. 2005; 80: 879-882https://doi.org/10.4065/80.7.879
- The interchondral joints of the human thorax.J Anat. 1925; 59: 432-437
- Slipping rib syndrome in a collegiate swimmer: a case report.J Athl Train. 2005; 40: 120-122
- Slipping rib syndrome in childhood.J Pediatr Surg. 1997; 32: 1081-1082https://doi.org/10.1016/S0022-3468(97)90403-6
- The slipping rib syndrome: a case report.Int J Surg Case Rep. 2016; 23: 23-24https://doi.org/10.1016/j.ijscr.2016.04.009
- Side strain: a tear of internal oblique musculature.Am J Roentgenol. 2003; 181: 1511-1517https://doi.org/10.2214/ajr.181.6.1811511
- Sonographic appearance of a tear of the lateral internal oblique muscle resulting from cough.J Clin Ultrasound. 2005; 33: 471-473https://doi.org/10.1002/jcu.20170
- Clinicoradiological diagnosis of cough-induced intercostal hernia.J Surg Tech Case Rep. 2013; 5: 106-108https://doi.org/10.4103/2006-8808.128754
- Sonography of occult rib and costal cartilage fractures: a case series.J Chiropr Med. 2014; 13: 139-143https://doi.org/10.1016/j.jcm.2014.06.008
- Costal cartilage fractures as revealed on CT and sonography.Am J Roentgenol. 2001; 176: 429-432https://doi.org/10.2214/ajr.176.2.1760429
- Isolated costal cartilage fracture: an unusual cause of an anterior chest mass in a toddler.Pediatr Radiol. 2009; 39: 985-987https://doi.org/10.1007/s00247-009-1276-8
Published online: March 13, 2019
Accepted: March 12, 2019
Received in revised form: March 2, 2019
Received: January 27, 2019
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