Rib fractures induced by coughing: An unusual cause of acute chest pain

doi:10.1016/S0735-6757(00)90019-6

The American Journal of Emergency Medicine

Volume 18, Issue 2, March 2000, Pages 194-197

https://doi.org/10.1016/S0735-6757(00)90019-6 Get rights and content

Abstract

We report three patients with stress fractures of the ribs induced by coughing. Standard radiographs of the chest and ribs did not reveal evidence of rib fractures in any of the patients. Bone scintigraphy, performed 1 to 2 weeks after initial onset of symptoms, showed a focal area of increased uptake along the chest wall in all cases. Thin section angulated helical CT directly visualized the subtle rib fractures. Initial diagnosis of a cough-induced fracture of the rib may be difficult because of the associated underlying disorder, and unnecessary examinations are commonly performed. Identification of a cough-induced fracture of the rib using helical CT may be clinically important to avoid unnecessary concern and additional examinations.

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Cited by (28)

Life-Threatening and Non-Life-Threatening Complications Associated With Coughing: A Scoping Review
2020, Chest
This is an update of the section on complications that are associated with coughing in the 2006 CHEST cough guidelines that addresses two aims: (1) to systematically identify and thematically categorize the diverse complications of cough by providing a guide for future studies and (2) to identify gaps in the literature for future research.
What are the potential complications that are associated with the act of coughing that have been reported in infants, children, adolescents, and adults?
A scoping review was performed with the use of PubMed and SCOPUS databases that were searched from their beginning until September 6, 2019.
Two hundred forty-seven publications met our inclusion criteria. To these, we added 38 articles from the 2006 complications paper that were not identified in the literature search plus the paper itself for a final total of 286 publications that formed the basis of this review. Since 2006, three new categories of complications have been reported: ear, nose and throat; disease transmission; and laboratory testing. Multiple additional complications that fall outside of these three categories have also been identified and included in the following categories: cardiovascular, constitutional symptoms, dermatologic, GI, genitourinary, musculoskeletal, neurologic, ophthalmologic, psychosocial/quality of life, and respiratory. Not previously highlighted is that some of the complications led to serious morbidity that included death, especially in patients with comorbid conditions, and potentially resulted in harm to others when cough resulted in a motor vehicle accident.
Our work identified a large number of cough complications that we thematically categorized primarily by organ system so that future studies of each system or each complication can be conducted. The gap in the literature that future studies should address is to identify the frequency of the complications and the strength of their association with cough. Only then will one be able to describe the findings in a manner that allows specific recommendations for avoiding these complications. In the meantime, patients with cough should be evaluated and treated according to evidence-based guidelines to mitigate or prevent the myriad of potential complications that are associated with coughing.
An Algorithm for the Diagnosis and Management of Chest Pain in Primary Care
2010, Medical Clinics of North America
Citation Excerpt :
Clinical features include pain on inspiration and chest or upper limb movements and localized tenderness at the site of the strain or fracture. Not all fractures may be detected by plain radiographs, so if a clinical suspicion of fracture remains, bone scintigraphy, CT scanning,73 or ultrasonography74 may be necessary. Fibromyalgia is a syndrome characterized by widespread chronic muscle pain and tenderness in multiple discrete points.70
Cough-induced rib fractures
2005, Mayo Clinic Proceedings
Citation Excerpt :
The cough-induced fractures in our study occurred primarily in women. A similar trend is seen in the case reports of cough-induced fractures published to date.1–9 This finding is likely related to differences between the sexes in bone density.
To define the demographic, clinical, and radiological features of patients with cough-induced rib fractures and to assess potential risk factors.
For this retrospective, single-center study, we identified all cases of cough-induced rib fractures diagnosed at the Mayo Clinic in Rochester, Minn, over a 9-year period between January 1, 1996, and January 31, 2005. Bone densitometry data from patients' medical records were analyzed, and T scores were used to classify patients into bone density categories.
The mean ± SD age of the 54 study patients at presentation was 55±17 years, and 42 patients (78%) were female. Patients presented with chest wall pain after onset of cough. Rib fracture was associated with chronic cough (≥3 weeks' duration) in 85% of patients. Rib fractures were documented by chest radiography, rib radiography, computed tomography, or bone scan. Chest radiography had been performed in 52 patients and revealed rib fracture in 30 (58%). There were 112 fractured ribs in 54 patients. One half of patients had more than 1 fractured rib. Right-sided rib fractures alone were present in 17 patients (26 fractured ribs), left-sided in 23 patients (35 fractured ribs), and bilateral in 14 patients (51 fractured ribs). The most commonly fractured rib on both sides was rib 6. The fractures were most common at the lateral aspect of the rib cage. Bone densitometry was done in 26 patients and revealed osteopenia or osteoporosis in 17 (65%).
Cough-induced rib fractures occur primarily in women with chronic cough. Middle ribs along the lateral aspect of the rib cage are affected most commonly. Although reduced bone density is likely a risk factor, cough-induced rib fractures can occur in the presence of normal bone density.
Cough-induced costal cartilage fracture
2019, Clinical Imaging
Citation Excerpt :
In the setting of trauma, musculoskeletal injury is the immediate diagnostic consideration, however the diagnosis may be less obvious in the absence of overt trauma. Rib fractures, diaphragm rupture, and muscular hematomas have all been described following violent fits of coughing [4–6]. Costal cartilage fractures are uncommon injuries that have been described after high energy blunt trauma, such as in athletes playing contact sports, however to our knowledge there have been no reports of cough-induced costal cartilage fracture [7–10].
We present two cases of atraumatic costal cartilage fracture secondary to violent coughing. Although costal cartilage fractures due to trauma and bony rib fractures due to violent coughing have been described, to our knowledge there have been no prior reported cases of cough-induced costal cartilage fracture. It is important for radiologists to consider costal cartilage fractures, which are often more subtle than osseous injuries, in patients with chest pain, and understand that they may not always be preceded by direct trauma. Identifying this injury is clinically important and will prevent patients from undergoing unnecessary examinations to rule out a cardiac cause of chest pain or a pulmonary embolism.
Cough-induced rib fractures: A comprehensive analysis of 90 patients in a single center
2024, Turkish Journal of Thoracic and Cardiovascular Surgery
A Colony without a Cough? A Bioarchaeological Exploration of Tuberculosis at the Eighteenth-Century Fortress of Louisbourg, Canada
2023, Historical Archaeology

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Rib fractures induced by coughing: An unusual cause of acute chest pain

Abstract

Injury

Am J Emerg Med

Injury

Clin Imag

Stress fractures of the ribs in golfers

Am J Sports Med

Stress fractures of the ribs in female rowers

Am J Sports Med