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Radiologic Imaging of Chest Injuries

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Nuclear Medicine and Radiologic Imaging in Sports Injuries

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Abstract

Chest pain is seldom a complaint of athletes. However sports injuries to the chest can be painful and life-threatening. Therefore it is important to choose the most reliable imaging modality to support the clinical diagnosis in the athlete with chest pain. In this chapter the role of radiology in various sports-related chest injuries is described, from the rarely described (but commonly diagnosed) costochondritis and sternal fractures to the more common rib fractures. The chest injury itself will be addressed first and then followed by the appropriate imaging modality and radiologic findings and characteristics. Traumatic as well as overuse injuries to the chest will be discussed. Emphasis will also be placed on ruling out any life-threatening complications by selecting the right imaging modality.

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Abbreviations

ALARA:

As low as reasonably achievable

AP:

Anterior-to-posterior direction

CT:

Computed tomography

ECG:

Electrocardiogram

FAT SAT:

Fat saturation

IOC:

International Olympic Committee

MRI:

Magnetic resonance imaging

PA:

Posterior-to-anterior direction

PTX:

Pneumothorax

SC:

Sternoclavicular

STIR:

Short-tau inversion recovery

TSE:

Turbo spin echo

US:

Ultrasound/ultrasonography

References

  • Al-Hassani A, Abdulrahman H, Afifi I, Almadani A, Al-Den A, Al-Kuwari A, Recicar J, Nabir S, Maull KI (2010) Rib fracture patterns predict thoracic chest wall and abdominal solid organ injury. Am Surg 76(8):888–891

    PubMed  Google Scholar 

  • Anderson MW (2006) Imaging of upper extremity stress fractures in the athlete. Clin Sports Med 25:489–504

    Article  PubMed  Google Scholar 

  • Aspegren D, Hyde D, Miller M (2007) Conservative treatment of a female collegiate volleyball player with costochondritis. J Manipulative Physiol Ther 30(4):321–325

    Article  PubMed  Google Scholar 

  • Barbaix EJ (1996) Stress fracture of the sternum in a golf player. Int J Sports Med 17(4):303–304

    Article  CAS  PubMed  Google Scholar 

  • Bar-Sever Z, Connolly LP, Treves ST (1997) Stress changes in the ribs associated with ballet dancing. Clin Nucl Med 22(4):263–264

    Article  CAS  PubMed  Google Scholar 

  • Blakeley CJ, Harrison HL, Siow S, Hashemi K (2011) The use of bedside ultrasound to diagnose posterior sterno-clavicular dislocation. Emerg Med J 28(6):542

    Article  CAS  PubMed  Google Scholar 

  • Bouma HW, Nelissen RGHH (2012) Een bodybuilder met een blessure. Ned Tijdschr Geneeskd 156:A3505

    PubMed  Google Scholar 

  • Brys P, Geusens E (2007) Scapular, clavicular, acromioclavicular and sternoclavicular joint injuries. In: Vanhoenacker FM, Maas M, Gielen GL (eds) Imaging of orthopedic sports injuries. Springer, Heidelberg

    Google Scholar 

  • Buckley BJ, Hayden SR (2008) Posterior sternoclavicular dislocation. J Emerg Med 34(3):331–332

    Article  PubMed  Google Scholar 

  • Buzzacott PL (2012) The epidemiology of injury in scuba diving. Med Sport Sci 58:57–79

    Article  PubMed  Google Scholar 

  • Carroll MB (2011) Sternocostoclavicular hyperostosis: a review. Ther Adv Musculoskelet Dis 3(2):101–110

    Article  PubMed Central  PubMed  Google Scholar 

  • Chaudhry FA, Killampalli VV, Chowdhry M, Holland P, Knebel RW (2011) Posterior dislocation of the sternoclavicular joint in a young rugby player. Acta Orthop Traumatol Turc 45(5):376–378

    PubMed  Google Scholar 

  • Connell DA, Potter HG, Sherman MF, Wickiewicz TL (1999) Injuries of the pectoralis major muscle: evaluation with MR imaging. Radiology 210(3):785–791

    Article  CAS  PubMed  Google Scholar 

  • Connolly LP, Connolly SA (2004) Rib stress fractures. Clin Nucl Med 29:614–616

    Article  PubMed  Google Scholar 

  • Cubos J, Cubos A, Di Stefano F (2010) Chronic costochondritis in an adolescent competitive swimmer: a case report. J Can Chiropr Assoc 54(4):271–275

    PubMed Central  PubMed  Google Scholar 

  • Curtin SM, Tucker AM, Gens DR (2000) Pneumothorax in sports: issues in recognition and follow-up care. Phys Sportsmed 28:23–32

    Article  CAS  PubMed  Google Scholar 

  • Davis PF (2002) Primary spontaneous pneumothorax in a track athlete. Clin J Sport Med 12:318–319

    Article  PubMed  Google Scholar 

  • De Castro Pochini A, Ejnisman B, Andreoli CV, Monteiro GC, Silva AC, Cohen M, Albertoni WM (2010) Pectoralis major muscle rupture in athletes: a prospective study. Am J Sports Med 38(1):92–98

    Article  PubMed  Google Scholar 

  • Dugdale TW, Fulkerson JP (1987) Pneumothorax complicating a closed fracture of the clavicle. A case report. Clin Orthop 221:212–214

    PubMed  Google Scholar 

  • Echlin PS, Michaelson JE (2006) Adolescent butterfly swimmer with bilateral subluxing sternoclavicular joints. Br J Sports Med 40:e12

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • ElMaraghy AW, Devereaux MW (2012) A systematic review and comprehensive classification of pectoralis major rupture. J Shoulder Elbow Surg 21:412–422

    Article  PubMed  Google Scholar 

  • Engin G, Yekeler E, GüloÄŸlu R, AcunaÅŸ B, AcunaÅŸ G (2000) US versus conventional radiography in the diagnosis of sternal fractures. Acta Radiol 41(3):296–299

    Article  CAS  PubMed  Google Scholar 

  • Gielen JL, Vanhoenacker FM, Van Dyck P (2007) Thoracic and abdominal wall injuries in sports. In: Vanhoenacker FM, Maas M, Gielen GL (eds) Imaging of orthopedic sports injuries. Springer, Heidelberg

    Google Scholar 

  • Gleason BA (2006) Bilateral, spontaneous, anterior subluxation of the sternoclavicular joint: a case report and literature review. Mil Med 171(8):790–792

    Article  PubMed  Google Scholar 

  • Gregory PL, Biswas AC, Batt ME (2002) Musculoskeletal problems of the chest wall in athletes. Sports Med 32(4):235–250

    Article  PubMed  Google Scholar 

  • Grindstaff TL, Beazell JR, Saliba EN, Ingersoll CD (2010) Treatment of a female collegiate rower with costochondritis: a case report. J Man Manip Ther 18(2):64–68

    Article  PubMed Central  PubMed  Google Scholar 

  • Groh GI, Wirth MA (2011) Management of traumatic sternoclavicular joint injuries. J Am Acad Orthop Surg 19(1):1–7

    PubMed  Google Scholar 

  • Hamburg C, Abdelwahab IF (1987) Reliability of computed tomography in the initial diagnosis and follow-up evaluation of Tietze’s syndrome: case report with review of the literature. J Comput Tomogr 11(1):83–87

    Article  CAS  PubMed  Google Scholar 

  • Harker CP, Neuman TS, Olson LK (1993) The roentgenographic findings associated with air embolism in sport scuba divers. J Emerg Med 11:443–449

    Article  CAS  PubMed  Google Scholar 

  • Hill PF, Chatterji S, DeMello WF, Gibbons JR (1997) Stress fracture of the sternum: an unusual injury? Injury 28(5–6):359–361

    Article  CAS  PubMed  Google Scholar 

  • Hiramuro-Shoji F, Wirth MA, Rockwood CA Jr (2003) Atraumatic conditions of the sternoclavicular joint. J Shoulder Elbow Surg 12:79–88

    Article  PubMed  Google Scholar 

  • Iwamoto J, Sato Y, Takeda T, Matsumoto H (2011) Analysis of stress fractures in athletes based on our clinical experience. World J Orthop 2(1):7–12

    Article  PubMed Central  PubMed  Google Scholar 

  • Jin W, Yang DM, Kim HC, Ryu KN (2006) Diagnostic values of sonography for assessment of sternal fractures compared with conventional radiography and bone scans. J Ultrasound Med 10:1263–1268

    Google Scholar 

  • Karlson KA (1998) Rib stress fractures in elite rowers. A case series and proposed mechanism. Am J Sports Med 26(4):516–519

    CAS  PubMed  Google Scholar 

  • Karnik AM (2001) Management of pneumothorax and barotrauma: current concepts. Compr Ther 27(4):311–321

    Article  CAS  PubMed  Google Scholar 

  • Keating TM (1987) Stress fracture of the sternum in a wrestler. Am J Sports Med 15(1):92–93

    Article  CAS  PubMed  Google Scholar 

  • Kizer KW, MacQuarrie MB (1999) Pulmonary air leaks resulting from outdoor sports. A clinical series and literature review. Am J Sports Med 27(4):517–520

    CAS  PubMed  Google Scholar 

  • Laffosse JM, Espié A, Bonnevialle N, Mansat P, Tricoire JL, Bonnevialle P, Chiron P, Puget J (2010) Posterior dislocation of the sternoclavicular joint and epiphyseal disruption of the medial clavicle with posterior displacement in sports participants. J Bone Joint Surg Br 92(1):103–109

    Article  PubMed  Google Scholar 

  • Little JP, Adam CJ (2011) Effects of surgical joint destabilization on load sharing between ligamentous structures in the thoracic spine: a finite element investigation. Clin Biomech (Bristol, Avon) 26(9):895–903

    Article  CAS  Google Scholar 

  • Lord MJ, Ha KI, Song KS (1996) Stress fractures of the ribs in golfers. Am J Sports Med 24:118–122

    Article  CAS  PubMed  Google Scholar 

  • Lyons I, Saha S, Arulampalam T (2010) Manubriosternal joint dislocation: an unusual risk of trampolining. J Emerg Med 39(5):596–598

    Article  PubMed  Google Scholar 

  • Macdonald PB, Lapointe P (2008) Acromioclavicular and sternoclavicular joint injuries. Orthop Clin North Am 39(4):535–545

    Article  PubMed  Google Scholar 

  • MacDuff A, Arnold A, Harvey J (2010) Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010. Thorax 65:667–669

    Article  Google Scholar 

  • Macones AJ, Fisher MS, Locke JL (1989) Stress-related rib and vertebral changes. Radiology 170:117–119

    Article  PubMed  Google Scholar 

  • Maffulli N, Pintore E (1990) Stress fracture of the sixth rib in a canoeist. Br J Sports Med 24(4):247

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Mahlfeld A, Franke J, Mahlfeld K (2001) Ultrasound diagnosis of sternum fractures. Zentralbl Chir 126(1):62–64

    Article  CAS  PubMed  Google Scholar 

  • Marnejon T, Sarac S, Cropp AJ (1995) Spontaneous pneumothorax in weightlifters. J Sports Med Phys Fitness 35:124–126

    CAS  PubMed  Google Scholar 

  • Matsumoto T, Fujita K, Fujioka H (2003) Stress fracture of the first rib in a soccer player: a rare etiology of shoulder pain. J Shoulder Elbow Surg 12(2):197–199

    Article  PubMed  Google Scholar 

  • Miles JW, Barrett GR (1991) Rib fractures in athletes. Sports Med 12(1):66–69

    Article  CAS  PubMed  Google Scholar 

  • Mohammed TLH, Kirsch J, Amorosa JK et al (1995, revised in 2011) American College of Radiology, ACR appropriateness criteria. http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/RibFractures.pdf. Assessed 28 Dec 2012

  • Mulder D, McDonagh D, Wilkinson M (2012) Chest and Abdomen, Thoracic injuries. In: Bahr R (ed) The IOC Manual of Sports Injuries. John Wiley & Sons Ltd, Chicester

    Google Scholar 

  • Navas A, Kassarjian A (2011) Bone marrow changes in stress injuries. Semin Musculoskelet Radiol 15(3):183–197

    Article  PubMed  Google Scholar 

  • Ohashi K, El-Khoury GY, Albright JP, Tearse DS (1996) MRI of complete rupture of the pectoralis major muscle. Skeletal Radiol 25(7):625–628

    Article  CAS  PubMed  Google Scholar 

  • Orava S, Jaakkola L, Kujala UM (1991) Stress fracture of the seventh rib in a squash player. Scand J Med Sci Sports 1:247–248

    Article  Google Scholar 

  • Partridge RA, Coley A, Bowie R, Woolard RH (1997) Sports-related pneumothorax. Ann Emerg Med 30(4):539–541

    Article  CAS  PubMed  Google Scholar 

  • Perron AD (2003) Chest pain in athletes. Clin Sports Med 22:37–50

    Article  PubMed  Google Scholar 

  • Pfeiffer RP, Young TR (1980) Case report: spontaneous pneumothorax in a jogger. Phys Sportsmed 8:65–67

    Google Scholar 

  • Phillips EH, Rogers WF, Gaspar MR (1981) First rib fractures: incidence of vascular injury and indications for angiography. Surgery 89(1):42–47

    CAS  PubMed  Google Scholar 

  • Prisk VR, Hamilton WG (2008) Stress fracture of the first rib in weight-trained dancers. Am J Sports Med 36(12):2444–2447

    Article  PubMed  Google Scholar 

  • Proulx AM, Zryd TW (2009) Costochondritis: diagnosis and treatment. Am Fam Physician 80(6):617–620

    PubMed  Google Scholar 

  • Provencher MT, Handfield K, Boniquit NT, Reiff SN, Sekiya JK, Romeo A (2010) Injuries to the pectoralis major muscle: diagnosis and management. Am J Sports Med 38(8):1693–1705

    Article  PubMed  Google Scholar 

  • Putukian M (2004) Pneumothorax and pneumomediastinum. Clin Sports Med 23:443–454

    Article  PubMed  Google Scholar 

  • Raghunathan R, Porter K (2011) Sternal fractures. Trauma 11:77–92

    Article  Google Scholar 

  • Rehman A, Robinson P (2005) Sonographic evaluation of injuries to the pectoralis muscles. Am J Roentgenol 184(4):1205–1211

    Article  Google Scholar 

  • Restrepo CS, Martinez S, Lemos DF, Washington L, McAdams HP, Vargas D, Lemos JA, Carrillo JA, Diethelm L (2009) Imaging appearances of the sternum and sternoclavicular joints. Radiographics 29:839–859

    Article  PubMed  Google Scholar 

  • Robertsen K, Vejen N, Kristensen O (1996) Manubrium sterni stress fracture: an unusual complication of non-contact sport. Br J Sports Med 30(2):176–177

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Rumball JS, Lebrun CM, Di Ciacca SR, Orlando K (2005) Rowing injuries. Sports Med 35(6):537–555

    Article  PubMed  Google Scholar 

  • Russi EW (1998) Diving and the risk of barotrauma. Thorax 53(Suppl 2):S20–S24

    Article  PubMed Central  PubMed  Google Scholar 

  • Sacchetti AD, Beswick DR, Morse SD (1983) Rebound rib: stress-induced first rib fracture. Ann Emerg Med 12(3):177–179

    Article  CAS  PubMed  Google Scholar 

  • Sakellaridis T, Stamatelopoulos A, Andrianopoulos E, Kormas P (2004) Isolated first rib fracture in athletes. Br J Sports Med 38:e5

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Salahuddin M, James LA, Bass ES (2011) SCUBA medicine: a first-responder’s guide to diving injuries. Curr Sports Med Rep 10(3):134–139

    Article  PubMed  Google Scholar 

  • Soundappan SVS, Holland AJA, Browne G (2005) Sports-related pneumothorax in children. Pediatr Emerg Care 21(4):259–260

    Article  CAS  PubMed  Google Scholar 

  • Taimela S, Kujala UM, Orava S (1995) Two consecutive rib stress fractures in a female competitive swimmer. Clin J Sport Med 5:254–257

    Article  CAS  PubMed  Google Scholar 

  • Thomas PL (1988) Thoracic back pain in rowers and butterfly swimmers – costo vertebral subluxation (Letter). Br J Sports Med 22:81

    Article  PubMed Central  PubMed  Google Scholar 

  • Turk F, Kurt AB, Saglam S (2010) Evaluation by ultrasound of traumatic rib fractures missed by radiography. Emerg Radiol 17:473–477

    Article  PubMed  Google Scholar 

  • Van Veen MJ, Klaase JM (2011) Een man met aanhoudende thoracale pijn. Ned Tijdschr Geneeskd 155(18):A1426

    PubMed  Google Scholar 

  • Volterrani L, Mazzei MA, Giodano N, Nuti R, Galeazzi M, Fioravanti A (2008) Magnetic resonance imaging in Tietze’s syndrome. Clin Exp Rheumatol 26:848–853

    CAS  PubMed  Google Scholar 

  • Warden SJ, Gutschlag FR, Wajswelner H, Crossley KM (2002) Aetiology of rib stress fractures in rowers. Sports Med 32(13):819–836

    Article  PubMed  Google Scholar 

  • Wheat Hozack MJ, Bugg B, Lemay K, Reed J (2013) Tears of pectoralis major in steer wrestlers: a novel repair technique using the EndoButton. Clin J Sport Med 23(1):80–82

    Article  PubMed  Google Scholar 

  • Wirth MA, Rockwood CA (1996) Acute and chronic traumatic injuries of the sternoclavicular joint. J Am Acad Orthop Surg 4:268–278

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Division of Musculoskeletal Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Anouk Marinke Barendregt & Mario Maas

Authors
  1. Anouk Marinke Barendregt
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  2. Mario Maas
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Correspondence to Anouk Marinke Barendregt .

Editor information

Editors and Affiliations

  1. Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Andor W.J.M. Glaudemans

  2. Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Rudi A.J.O. Dierckx

  3. Department of Radiology, Antwerp University Hospital, Edegem, Belgium

    Jan L.M.A. Gielen

  4. Exercise and Health, Center for Sports Medicine, University Center for Sport, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Johannes (Hans) Zwerver

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Barendregt, A.M., Maas, M. (2015). Radiologic Imaging of Chest Injuries. In: Glaudemans, A., Dierckx, R., Gielen, J., Zwerver, J. (eds) Nuclear Medicine and Radiologic Imaging in Sports Injuries. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-46491-5_14

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  • DOI: https://doi.org/10.1007/978-3-662-46491-5_14

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