CASE 544 Published on 24.10.2000

Teaching Case

Section

Chest imaging

Case Type

Clinical Cases

Authors

M. Wintermark, P. Schnyder

Patient

45 years, male

Categories

No Area of Interest ; Imaging Technique CT ;

No Procedure ; No Special Focus ;

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Clinical History

Traffic accident

Differential Diagnosis List

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

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.

References

[1] Ciraulo DL, Elliott D, Mitchell KA, Rodriguez A.
Flail chest as a marker for significant injuries.
J Am Coll Surg. 1994 May;178(5):466-70. (PMID: 8167883)

[2] Freedland M, Wilson RF, Bender JS, Levison MA.
The management of flail chest injury: factors affecting outcome.
J Trauma. 1990 Dec;30(12):1460-8. (PMID: 2258956)

[3] Jackson A, Fields JM, Wong-You-Chong JJ.
The costal hook: an indicator of occult flail segment in chest trauma.
Eur J Radiol. 1991 Jul-Aug;13(1):69-71. (PMID: 1889434)

[4] Wintermark M, Schnyder P
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 (2000).

Case information