Bony Thorax Case 1 Diagnosis

Chest x-ray is the initial test of choice when evaluating for rib fractures. However, the overall sensitivity is poor, and x-rays may miss up to 50% of rib fractures. The primary role of the chest x-ray is to rule out associated more threatening injuries such as pneumothorax and hemothorax. Ordering dedicated rib series x-rays increases the sensitivity at the expense of more imaging.

Ultrasound can demonstrate rib fractures, and has been shown to outperform chest x-ray.  Ultrasound can also be useful in revealing rib fracture complications such as pneumothorax or hemothorax. However, ultrasound is operator dependent and has not been widely accepted as the sole imaging test in evaluation of traumatic chest pain.

CT is best utilized to evaluate for other thoracic injuries, not simply to diagnose rib fractures.  CT is seldom indicated in minor trauma after a negative chest x-ray.