AssessmentsAnatomy clinical correlates: Thoracic wall
USMLE® Step 1 style questions USMLE
USMLE® Step 2 style questions USMLE
A 16-year-old boy comes to his outpatient provider for evaluation of exercise intolerance. His symptoms have been ongoing for many years but have recently become more bothersome after he started playing soccer for his high school team. He fatigues more easily than his friends and cannot keep up with them during matches. The patient also experiences frequent bruising after minor falls. Family history is noncontributory. In the office, his temperature is 37.1°C (98.8°F), blood pressure is 108/73 mmHg, pulse is 65/min, and respiratory rate is 15/min. Physical examination reveals hyperelastic skin, hypermobile joints and multiple bruises over the bilateral lower extremities. Examination of the chest reveals the following finding:
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Which of the following is the most likely underlying etiology of this patient’s symptoms?
Content Reviewers:Viviana Popa, MD, Scott Caterine, BSc (Hons.), MSc, MB, BCh, BAO (Hons.)
If it wasn't for our thoracic wall, many of the important organs in our thoracic cavity would be unprotected and vulnerable to injury.
But sometimes the thoracic wall itself can be injured, which has a wide range of clinical consequences depending on the affected structures.
Let’s start by talking about the ribs.
These usually result from direct trauma or crushing injuries.
The weakest part of a rib is the posterolateral bend, anterior to its angle.
However, direct trauma can cause a rib to fracture anywhere.
Furthermore, rib fractures at any level have the risk of causing an intrathoracic injury such as a pneumothorax, which is when there’s air in the pleural cavity, and that doesn’t allow the lung on that side to expand properly.
During a normal inspiration, the thoracic wall expands outwards and increases its diameter, whereas during expiration, it decreases its diameter to expel air.
This is an extremely painful injury that impairs ventilation, and, as a consequence, blood isn’t properly oxygenated.
Management wise, for a flail chest, you want to ensure adequate pain control and supplemental oxygen if needed.
Sometimes, a chest tube may also be required.
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