Nontraumatic rupture of the costal margin: a single-center experience. (February 2019)

• Record Type: Journal Article
• Authors: Mary Parks, Ruth; Jadoon, Mehmood; Duffy, John
• Is Part Of: Asian cardiovascular & thoracic annals. Volume 27:Number 2(2019)
• Page Start: 105
• Page End: 109
• Publication Date: 2019-02
• Subjects: Cough -- Fractures -- spontaneous -- Hernia -- Pulmonary disease -- chronic obstructive -- Rib fractures -- Thoracic wall; Heart -- Diseases -- Asia -- Periodicals; Heart -- Diseases -- Pacific Area -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Surgery -- Asia -- Periodicals; Heart -- Surgery -- Pacific Area -- Periodicals; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Asia -- Periodicals; Chest -- Surgery -- Pacific Area -- Periodicals; Chest -- Surgery -- Periodicals; 617.412
• DOI: 10.1177/0218492318823367
• Languages: English
• ISSNs: 0218-4923

Abstract

Background: Rupture of the costal margin is uncommon. Whilst most often seen after major trauma, we describe its occurrence in patients with no direct chest trauma. Methods: A search was performed in our thoracic surgery database for all patients with rupture of the costal margin. Patients were excluded if the injury was a result of trauma. Data were collected on sex, age, body mass index, profession, past medical history, smoking status, presenting complaint, mechanism of injury, and management. Results: There were 9 patients with rupture of the costal margin that was caused in all cases by a severe coughing fit. All patients were male and the mean age was 62.5 years (range 47–76 years). Chronic obstructive pulmonary disease was present in 6 cases. Presentations included a palpable defect (5 cases), cough (9 cases), and chest pain (6 cases). On radiological examination, all patients had widening of the rib space, 4 had associated rib fractures, and 5 had lung herniation. Time from injury to presentation was 12 months (range 1–24 months). All patients underwent surgery and were followed-up for 59 months (range 8–129 months). Two patients suffered major complications in the immediate postoperative period. Conclusions: Rupture of the costal margin, in the absence of direct trauma, is characterized by pain, a palpable defect, and lung herniation. It is associated with widening of the rib space and rib fractures, and can be treated surgically with success but not without significant risks.