Hanak et al described the clinical features associated with rib fractures caused by coughing. The authors are from the Mayo Clinic.
(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:
(2) metastatic carcinoma
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