Chetana Shanmukhappa Sanjana, Malik Muhammad Ahmed, Akula Navya, Shaukat Fahd
Rochester Regional Health/Unity Hospital, Rochester, New York, USA.
University Hospitals/Case Western Reserve University/Harrington Heart and Vascular Institute, Cleveland, Ohio, USA.
Eur J Case Rep Intern Med. 2023 Mar 13;10(3):003812. doi: 10.12890/2023_003812. eCollection 2023.
Rib fractures are an infrequent consequence of severe cough. In some patients, undetected rib fractures can lead to life-threatening outcomes. The case of a 73-year-old man who presented with shortness of breath and a worsening dry cough from a SARS-CoV-2 infection for 4 weeks is described. In the emergency department, he was found to be hypoxic and hypotensive. Imaging studies revealed a large right pleural effusion, multiple rib fractures, and right-sided herniation of the colon into the chest. He was admitted to the cardiothoracic intensive care unit where he underwent a flexible bronchoscopy, right video-assisted thoracoscopic surgery, evacuation of a haemothorax, complete decortication, and repair of a diaphragmatic hernia. This case is an unusual presentation of an amalgamation of rare complications resulting from an unrelenting, poorly controlled SARS-CoV-2 infection cough that prompted rapid recognition and swift action.
Physical examination and plain radiography frequently miss costal arch fractures if no bone pathology or history of trauma is present.Controlling cough is important, and decreases the chances of complications and rupture of organs.New-onset chest pain with a background of chronic cough makes cough-induced rib fracture a probable differential diagnosis. Pleural effusion in a patient presenting with cough and a rib fracture should make clinicians suspect haemothorax.
肋骨骨折是严重咳嗽罕见的后果。在一些患者中，未被发现的肋骨骨折可能导致危及生命的后果。本文描述了一名73岁男性的病例，该患者因感染SARS-CoV-2出现气短和干咳加重4周。在急诊科，发现他存在低氧血症和低血压。影像学检查显示右侧大量胸腔积液、多处肋骨骨折以及结肠右侧疝入胸腔。他被收入心胸重症监护病房，在那里接受了可弯曲支气管镜检查、右侧电视辅助胸腔镜手术、血胸引流、完全剥脱术以及膈肌疝修补术。该病例是由持续、控制不佳的SARS-CoV-2感染咳嗽导致的罕见并发症合并出现的不寻常表现，促使迅速识别并采取了迅速行动。
如果没有骨病变或外伤史，体格检查和X线平片经常会漏诊肋弓骨折。控制咳嗽很重要，可降低并发症和器官破裂的几率。在慢性咳嗽背景下新发胸痛使咳嗽引起的肋骨骨折成为可能的鉴别诊断。伴有咳嗽和肋骨骨折的患者出现胸腔积液应使临床医生怀疑血胸。
