- Details
- Hits: 10890
User Rating: 5 / 5
Random Case Generator
You Flail I Wail
A 34-year-old male patient presents after being hit by a car while riding a motorcycle. The patient is in severe respiratory distress and a portion of his chest wall appears to be moving paradoxically to his respirations.
You Flail I Wail
Author: Haroon Choudry, MS4, Justine Ko, MD, CAQ-SM
Peer and Final Editor: Alex Tomesch, MD, CAQ-SM
A 34-year-old male patient presents after being hit by a car while riding a motorcycle. The patient is in severe respiratory distress and a portion of his chest wall appears to be moving paradoxically to his respirations.
Image 1. Plain radiograph of the chest. (Case courtesy of Ian Bickle, Radiopaedia.org, rID: 37961)
What is the diagnosis?
This patient is diagnosed with flail chest. It is largely a clinical diagnosis based on the classic paradoxical chest movements that result when multiple ribs are broken in two or more places [1].
Image 2: Plain radiograph of the chest. Annotation by author. (Case courtesy of Ian Bickle, Radiopaedia.org, rID: 37961)
Which imaging modalities can be used?
Plain radiographs of the chest should be ordered for initial assessment and evaluation of hemothorax and pneumothorax. However, chest x-ray is less sensitive than CT for diagnosis of rib fractures and flail chest (Image 3) [2].
Image 3: CT chest image that demonstrates multiple overlying depressed right rib fractures (1st - 9th) with subcutaneous emphysema. Extensive right pulmonary contusion is seen. Case courtesy of RMH Core Conditions, Radiopaedia.org, rID: 26294)
References
[1] Perera TB, King KC. Flail Chest. In: StatPearls. StatPearls Publishing; 2022. Accessed October 28, 2022. PMID: 30475563
[2] Dogrul BN, Kiliccalan I, Asci ES, Peker SC. Blunt trauma related chest wall and pulmonary injuries: An overview. Chin J Traumatol. 2020;23(3):125-138. PMID: 32417043
[3] Majercik S, Pieracci FM. Chest Wall Trauma. Thorac Surg Clin. 2017 May;27(2):113-121. PMID: 28363365.
[4] Iqbal HJ, Alsousou J, Shah S, et al. Early surgical stabilization of complex chest wall injuries improves short-term patient outcomes. J Bone Joint Surg Am 2018;100:1298-308. PMID: 3006359
All content on the Ortho EM Pearls website is purely educational and should not be construed as medical advice. The content and all associated information on this website is not intended to diagnose, treat, cure, or prevent any disease. Please seek care from a medical professional and if you are having a medical emergency, please call 911.
Ortho EM Pearls is a 501(c)(3) nonprofit organization.
© 2021 by ShamiDesigns. All rights reserved.