Clinical features:
(1) The onset of chest pain follows an episode of coughing.
(2) The lateral aspects of the middle ribs are most commonly involved , with the 6th rib the most commonly affected.
(3) A patient may have from 1 to many rib fractures.
(4) It is necessary to exclude of other causes of chest pain.
Some cases may be misdiagnosed as cough-induced muscle strain.
Risk factors for cough-induced rib fractures:
(1) more common with chronic (>= 3 weeks) than acute (< 3 weeks) cough
(2) more common in women
(3) more common in patients with osteoporosis
The rib fractures are best seen on CT scan or Technetium 99 bone scan. Routine chest X-rays may miss many fractures.
The diagnosis of cough-induced rib fracture requires the exclusion of other causes of rib fracture:
(1) trauma
(2) metastatic carcinoma
(3) exercise
