Cough-induced rib fracture in 44-year-old after infectious cough
Cough-induced rib fracture is a type of rib fracture that generally occurs after an infectious cough, postnasal drip, asthma attack and bronchitis. A symptom of the fracture includes a sudden onset of chest pain after the cough. The fractures commonly occur in the 5th and 10th ribs lateral aspect because of their vulnerability to shear forces. In 30% of patients with cough-induced rib fractures there is no underlying disease. Therefore, it can occur in patients who are healthy adults and have no specific risk factor. However, rib fractures are a common risk factor of pneumonia and empyema. Rib fractures because of trauma worsen sputum drainage causing pain and flail chest syndrome. In a similar case, a 44-year-old presented to the emergency with cough-induced rib fracture.
The patient complained of a persistent cough and anterior chest pain that developed after coughing.
He also complained of pain in the right lung while breathing. For this reason, making it difficult for him to take deep breaths. Doctors advised a chest CT. Findings of the CT showed a fracture in the 7th rib on the right with pleural effusion and consolidation. In addition, fluid culture test was positive for methicillin-susceptible Staphylococcus aureus. Based on the investigation findings, doctors diagnosed the patient with empyema associated with a cough-induced rib fracture. Treatment included placement of a thoracic drainage tube which helped improve his condition.
Doctors sent him home after 13 days with prescription of an 8-week course of antibiotic therapy. The patient showed no clinical relapse at 6-month follow-up. On follow-up and outcome, the authors of the study state, “two months after discharge from our hospital, chest CT revealed that the pleural effusion had markedly improved. The patient completed the 8-week course of cephalexin therapy, and no relapse was noted at the 6-month follow-up. The rib fracture was treated conservatively, and posterior follow-up CT showed bone fusion had occurred. Bone densitometry revealed osteopenia: the T-score of the lumbar spine was −1.6 and that of the total hip was −2.0”.
References
Empyema associated with a cough-induced rib fracture https://casereports.bmj.com/content/14/5/e242656
