CASE 544 Published on 24.10.2000
0

Costal hook sign as a radiological pattern of flail chest

Section

Chest imaging

Case Type

Clinical Cases

Authors

M. Wintermark, P. Schnyder

Connected authors
Pierre SCHNYDER SWITZERLAND
Patient

45 years, male

Categories
No Area of Interest ; Imaging Technique CT
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Clinical History
Traffic accident
Imaging Findings
45-year-old male patient run over by a truck
Discussion
Three or more adjacent fractured ribs, when broken at least on two different sites, result in a chest wall area isolated from the rest of the thoracic bone cage. This isolated chest wall flap, called a "flail chest", allows for paradoxical motion during breathing and may be responsible for ventilatory failure. Flail chests are encountered in less than 10% of blunt chest trauma patients. They are associated with an elevated mortality rate (up to 40%). The “costal hook” sign indicates posterior flail chest. Rotational displacement of posterior rib segments gives a characteristic hook-like configuration to the sites of successive rib fractures.
Differential Diagnosis List
Right flail chest featuring a costal hook sign on the plain film
Final Diagnosis
Right flail chest featuring a costal hook sign on the plain film
Case information
URL: https://eurorad.org/case/544
DOI: 10.1594/EURORAD/CASE.544
ISSN: 1563-4086
Figure 1

Right flail chest featuring a costal hook sign on the plain film

Right flail chest featuring a costal hook sign on the plain film
Admission plain film of the chest discloses a "costal hook" sign (arrow) as a typical pattern of flail chest. The ipsilateral hemithorax is partially blurred due to concomittant presence of a hemothorax. Subcutaneous and muscular emphysema is also portrayed (From Wintermark M, Schnyder P (2000) Trauma of the chest wall. In Schnyder P, Wintermark M. Radiology of blunt trauma of the chest. Springer, Berlin Heidelberg New York, pp 9-27)
Right flail chest featuring a costal hook sign on the plain film
Spiral CT sections (3-mm) portray the flail chest as striking serial double rib fractures. The hemothorax results in a right lung collapse and justified chest tube insertion
Right flail chest featuring a costal hook sign on the plain film
Spiral CT sections (3-mm) portray the flail chest as striking serial double rib fractures. The hemothorax results in a right lung collapse and justified chest tube insertion