Accuracy of radiologic diagnostic of rib fractures in blunt thoracic trauma

M.Dragu, M. Marinescu, A. Salem

Abstract: Accuracy of radiologic diagnostic of rib fractures in blunt thoracic trauma. We have compared the clinical and post-mortem diagnosis concerning rib fractures on 116 patients selected from a larger lot of patients with lethal blunt thoracic trauma. The study was focused on the comparison of costal ribs fractures diagnosed either by chest radiography or chest CT, and the necroptic findings of those patients. The results were clearly not in favor of chest radiography: the diagnosis based on chest radiography was confirmed only in 13,3% of cases (9 out of 68 patients), whereas in 31,2% of the patients who underwent CT-scan examination the diagnosis was confirmed (15 out of 48 cases). The accuracy of the diagnosis was higher in the cases with minor/moderate severity trauma (under 5 rib fractures): 20% on chest X-ray and 37,5% on CT-scan, with an overall percent of 25%. In other 33,8% of the patients diagnosed by chest X-ray, respectively 20,8% of the CT-scan the diagnosis was partially confirmed (the number of rib fractures varying only by one or two fractures), supporting the idea that the imaging diagnosis is more reliable, especially for clinical use, in approximately half of the patients with blunt chest trauma. Within the cases diagnosed with no rib fractures, this diagnosis was confirmed only in 12,5% (5 patients out of 40), whereas the other 87,5% had up to 5 rib fractures, situated mostly on the anterior and posterior costal arch. Subsequently, it seems that the lateral arch rib fractures are easier to diagnose that the previous.
Keywords: Rib fracture, Chest radiography, Imaging diagnosis, Post mortem findings