Case

A 13 year old patient is brought into the emergency room complaining of intermittent pain immediately lateral to the left edge of their sternum. There is pain when taking a deep breath or when coughing. They heard a “popping/click” sound earlier in the day and have had pain ever since. Physical exam confirms the point of maximum discomfort is just lateral to the left sternum.

Question 2/2 - What tests would you do to confirm or rule out your diagnosis?

Click on your selected option(s) below  (correct = 2, over-thinking = 3+)

Case Complete

Incorrect. Cartilage does not show up well with X-rays, so the ability to spot a cartilage break with an X-ray is limited.

Incorrect. Cartilage does not show up well with X-rays, so the ability to spot a cartilage break with an X-ray is limited. 

Incorrect. Cartilage does not show up well with X-rays, which are the basis for CT imaging.  Although CT provides better details than a plain film, even with CT the ability to spot a cartilage break is limited.

Correct! MRI provides excellent soft tissue resolution allowing for accurate viewing of the cartilage structures.

Incorrect. This would be traumatic and unnecessary for resolving a cartilage fracture. It is rarely of any value when looking inside a pleural space (primary use in the thoracic region is transoral esophageal lumen or airway lumen imaging).

Correct! The physical examination and patient history are sufficient for a high probability of a cartilage injury. Since additional information is unlikely to change your treatment, it would be satisfactory to proceed without advanced imaging. The treatment for any rib or related fracture is to manage with rest and allow time to heal.