Cough Induced Rib Fracture in Pregnant Patient: Role of Ultrasound

Abstract

Dear Editor,

Cough induced rib fractures during pregnancy are rare and pose unique diagnostic challenges due to the need for minimizing fetal radiation exposure. We present a case of 30 years old pregnant woman in her third trimester who experienced acute chest pain following a severe cough episode. Due to potential risks associated with radiographic imaging, a chest ultrasound was utilized, effectively identifying a fracture in the right 10th rib. This case underscores the critical role of ultrasound in safely and accurately diagnosing rib fractures in pregnant patients, offering a reliable and radiation-free alternative to traditional imaging methods.

A 30-year-old female patient who was 27 weeks pregnant presented with acute chest pain following a severe cough episode. She has no known disease and no abnormal findings were found during routine checks during her pregnancy. The examination revealed no findings other than tenderness in the right upper quadrant. An increase in WBC (11.83 10^3/uL) and CRP (22 mg/L) values was detected in laboratory tests. Laboratory values were thought to be due to upper respiratory tract infection and ultrasonography was performed for right upper quadrant pain. Liver echogenicity and size, gallbladder and right kidney were evaluated as normal in abdominal ultrasonography. In the examination performed with superficial probe on the local area where pain was described, discontinuity and stepping signs were observed in the outer contour of the right 10th rib (Figure 1). It was determined that the patient’s pain increased when light pressure was applied with the probe to the location where these findings were found. As a result of the examination and ultrasonography findings, a diagnosis of rib fracture was made. No hematoma or space-occupying lesion was detected in the surrounding tissues. No signs of fracture were detected by ultrasonography in the 9th and 11th ribs or the other ribs. Medical treatment was given to the patient who had a single rib fracture and no examination or ultrasonography findings suggestive of pneumothorax.