Detection of Sternum Fracture with POCUS Despite Normal Computed Tomography Findings: A Case Report

Year 2023, Volume: 14 Issue: 4, 77 - 80, 31.12.2023

Songül Tomar Güneysu , Mehmet Ali Aslaner , Okşan Derinöz-güleryüz

https://doi.org/10.33706/jemcr.1311287

Abstract

Sternal fractures are extremely rare in children. It often develops after high-energy chest trauma. Many methods other than ultrasonography are used in the diagnosis of sternal fractures. However, Point-of-care ultrasound (POCUS) can outperform other methods due to its ease of use, less radiation and fast results. A thirteen-year-old male patient was brought due to chest pain that started after blunt chest trauma after falling from a height. In her initial evaluation in the trauma room, the patient's respiratory and cardiovascular examinations were found to be normal. On palpation, there was local tenderness in the middle 1/3 of the sternum. No pathology was detected in E-FAST. The portable chest radiograph was normal. POCUS was performed after the patient did not respond to analgesic treatment and had local sensitivity on the sternum. A sternal fracture was detected. Suspicious cortical irregularity was detected in repeated chest X-ray and thorax CT was reported as normal. When CT was re-evaluated, a wet tree fracture was observed in the sternum body. The patient was discharged without any complications. In this article, the importance of diagnosing a sternal fracture case whose computed tomography was reported as normal with POCUS and integrating rapid, noninvasive and radiation-free ultrasonography into the physical examination will be discussed in the management of these patients.

Keywords

sternal fracture, trauma, POCUS

References

• Ferguson LP, Wilkinson AG, Beattie TF. Fracture of the sternum in children. Emergency Medicine Journal 2003; 20(6): 518-20.
• Ramgopal S, Shaffiey SA, Conti KA. Pediatric sternal fractures from a Level 1 trauma center. Journal of Pediatric Surgery 2019; 54(8): 1628-31.
• Holmes JF, Sokolove PE, Brant WE, Kuppermann N. A clinical decision rule for identifying children with thoracic injuries after blunt torso trauma. Annals of Emergency Medicine 2002; 39: 492-9.
• Gittelman MA, Gonzalez-del-Rey J, Brody AS, DiGiulio GA. Clinical predictors for the selective use of chest radiographs in pediatric blunt trauma evaluations. Journal of Trauma and Acute Care Surgery 2003; 55(4): 670-6.
• Kim EY, Yang HJ, Sung YM, Hwang KH, Kim JH, Kim HS. Sternal fracture in the emergency department: diagnostic value of multidetector CT with sagittal and coronal reconstruction images. European Journal of Radiology 2012; 81(5): e708-e711.
• Perez MR, Rodriguez RM, Baumann BM, Langdorf MI, Anglin D, Bradley RN, Raja AS. Sternal fracture in the age of pan-scan. Injury 2015; 46: 1324-7.
• Sesia SB, Prüfer F, Mayr J. Sternal fracture in children: diagnosis by ultrasonography. European Journal of Pediatric Surgery Reports 2017; 5(01): e39-e42.
• Khalil PA, Benton C, Toney AG. Point-of-care ultrasound used to diagnose sternal fractures missed by conventional imaging. Pediatric emergency care 2021; 37(2): 106-7.
• You JS, Chung YE, Kim D, Park S, Chung S. Role of sonography in the emergency room to diagnose sternal fractures. Journal of Clinical Ultrasound 2010; 38(3): 135-7.
• Racine S, Drake D: BET 3: Bedside ultrasound for the diagnosis of sternal fracture. Emergency Medicine Journal 2015; 32(12): 971–2.