多发性肋骨骨折影像学诊断的临床应用价值一例

Apatientwithmultipleribfractures:ImagingmodalitiesandclinicalsignificanceAlvinJ.GarciaMSIIICoreRadiologyClerkshipAgendazPresentationofpatientzBasicanatomyofribszMenuofradiologicaltestszWhentoimagetheribsandtheirsignificancezCausesofribfracturesandassociatedcomplicationsOurPatientzA34yearoldfemalepedestrianpresentstotheEDafterbeinghitbymovingvehicleonherleftsideataspeedof30mphwhilecrossingstreet,andlandedonthehoodofcar.zShehadnolossofconsciousness.zShewasbroughttoEDbyambulance.zPatientwashemodynamicallystablewithgoodventilation.VitalsignswerewithinnormallimitsandshewasAOx3.zPhysicalexamwasnormalexceptforleftsidedchestwallpainandaleftelbowlaceration.zHerlabworkwasunremarkable.AgendazPresentationofpatientzBasicanatomyofribszMenuofradiologicaltestszWhentoimagetheribsandtheirsignificancezCausesofribfracturesRibAnatomyzThoraxconsistsofthe12ribs,sternum[withmanubrium(M),sternum(S),xiphoid(X)]andclavicle(C).zScapulaislocatedposteriorly.zFirst7ribsareconnectedwiththevertebralcolumn,posteriorly,andwiththesternum,anteriorly,bymeansofthecostalcartilages.Socalled,trueribszRibs8-10areattachedtothecartilageoftheribabove.zThe11thand12thribsarefreeanteriorly.Imagesource:RibFractures.–costovertebraljunctionzVB–vertebralbodyzCCJ–costochondraljunctionzS-sternumImagesource:RibFractures.:DotyCIandSinertRH.:zChestX-rayzComputedtomographyzUltrasoundzMRIzBoneScanzSinglePhotonEmissionCT(SPECT)Menuofradiologicaltests:ChestX-rayzInitialstudyofchoice.zCXRmaymissupto50%ofribfractures,butisstilluseful.zNotsensitiveforcostalcartilageorstressfracture.zAlso,importantfordiagnosingprocessesassociatedwithribfracturessuchas:pnuemothoraxhemothoraxpulmonarycontusionpneumomediastinumpneumoperitoneumaorticinjury.Source:BhavnagriSJandMohammedTLH.Thereisasubtlestep-offpattern.Patientwasimagedwithtraumaboard.TraumaboardPACS,BIDMCOurpatient:APChestX-rayshowingfracturesofthe4thand5thRibs.Menuofradiologicaltests:UltrasoundAdvantageszmoresensitivethanchestradiograph(78%vs.12%).zDetectscostalcartilagefracturesandcostochondraljunctionfracturesbetterthanradiography.zviewofmultipleplanesandvisualizeinrealtime.zYoucanscanentireribatsiteofmaximaltendernessandthenadjacentribs.Onceribfracturediagnosed,onecanquicklyruleoutpneumothoraxandhemothoraxaswell.DrawbackszNotwidelyused.zTimeconsumingandmorecostlythanplainradiograph.zSkilldependentzCan'tassessfirstribunderclavicleandupperribsunderscapula.zRolelimitedtosituationsinwhichthediagnosisofaribfracturealoneisimportantChan,JJetal.Emergencybedsideultrasoundforthediagnosisofribfractures.AmericanJournalofEmergencyMedicine(2009)27,617–620:RibUltrasoundChan,JJetal.Emergencybedsideultrasoundforthediagnosisofribfractures.AmericanJournalofEmergencyMedicine(2009)27,617–620:ComputedTomographyAdvantageszBestmodalitytovisualizeribszMayhelpdetectfracturelines,fracturefragments,callusformation,pleuralhematoma,orpnuemothorax.zCanbeusedtoevaluatecostalcartilageinjury.zSpecificbonereconstructionalgorithmsand3DreconstructionsimprovedetectionbyCT.DisadvantagezCostly,timeconsuming,notalwaysavailable,radiationexposureSource:BhavnagriSJandMohammedTLH.Menuofradiologicaltests:RNBoneScan,SPECT,MRIzsensitivebutnotspecificzTechnetium(Tc99m)methylenediphosphonatebonescanningRadionuclideBonescanSPECTMRI•canhelplocalizeabnormalhotspotonbone•canrepresentnumberofconditionsbesideribfracture.•verysensitiveforstressfractures.•NoroleyetinribfractureevaluationSource:BhavnagriSJandMohammedTLH.AgendazPresentationofpatientzBasicanatomyofribszMenuofradiologicaltestszWhentoimagetheribsandtheirsignificancezCausesofribfracturesRecommendedclinicalmanagementofpatien