Hanak et al described the clinical features associated with rib fractures caused by coughing. The authors are from the Mayo Clinic.


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


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