CHAPTER 9 Abnormal ribs
9.1 Rib fractures
Your examination of the chest X-ray is not completed until you have looked carefully at the ribs. They should be of a uniform density with smoothish, unbroken edges. The main abnormalities to look for are old and new fractures and metastases.
1. New fractures. Look along the edges of each rib. A new fracture will be seen as a break in the edge. Once you have spotted a fracture look for more information. Look at the position of the fracture. A fracture of any of the first three ribs is unusual and implies tremendous force. Look for other fractures. A line of fractures suggests a traumatic injury whereas fractures scattered throughout the ribs may suggest repeated injury (as in an alcoholic) or underlying bony weakness (as in malignant disease). Look at the density of the ribs and compare them in your mind to other X-rays you have seen. If the ribs are less white than usual this suggests underlying decrease in bone density. Finally look for the complications of rib fractures – surgical emphysema, pneumothorax and haemothorax. Remember also that damage to the lower three ribs may result in hepatic, splenic or renal injury.
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