To define the demographic, clinical, and radiologic features of patients with cough-induced rib fractures.
Retrospective single-center study. Fifty-four patients with cough-induced rib fractures diagnosed over an 9-year period from 1996 to 2004.
The mean (± SD) age at presentation was 55 (± 17) years, 42 patients were female (78%). Patients presented with chest wall pain following the onset of cough. Cough had been present for ≥ 3 weeks at the time of the diagnosis in 85% of patients. Rib fractures were radiologically documented by chest radiography, rib film, computed tomography or bone scan. Chest radiography had been performed in 52 patients and revealed rib fracture in 30 patients (58%). There were 112 fractured ribs in 54 patients. One-half of the patients had more than one fractured rib. Right-sided rib fractures alone were present in 17 patients (26 fractured ribs), left-sided in 23 patients (35 fractured ribs), and bilateral in 14 patients (51 fractured ribs). The most commonly fractured rib on both sides was the 6th rib. The fractures were most common at the lateral aspect of the rib cage. Bone densitometry was done in 26 patients and revealed osteopenia or osteoporosis in 17 (65%).
Cough-induced rib fractures occur mostly in women in whom reduced bone density is likely a risk factor. However, cough-induced rib fractures can occur in the presence of normal bone density. Chest radiography has a relatively low sensitivity for the diagnosis of cough-induced rib fractures.
Cough-induced rib fractures are associated with chronic cough as opposed to acute cough, prevalence is much higher in females compared to males, and fractures may also occur in patients with normal bone density.
Viktor Hanak, None.