CRA28 A CASE SERIES OF UNEXPECTED RIB FRACTURE: WHEN COUGH LEAVE ITS MARK

Kum Yik Zhi1, Ummi Nadira Daut2, Tasnim Abdul Aziz2
1University Putra Malaysia, Serdang, Selangor, Malaysia
2Hospital Sultan Abdul Aziz Shah, Serdang, Selangor, Malaysia

Introduction:

Cough-induced rib fractures are uncommon injuries caused by severe or prolonged coughing, presenting with localized pain that worsens with breathing, diagnosed through imaging, and typically managed with pain control and rest, though they can occasionally lead to complications, especially in individuals with underlying health conditions. 

Case presentation: 

Case 1: A 22-year-old man without recent trauma history who developed a prolonged cough with right sided chest pain, rapidly progressing to respiratory failure requiring intubation. Imaging revealed a left pleural effusion, and CT scan showed a surprising right 10th rib fracture and left loculated hydropneumothorax. Treatment included chest tube insertion for the left-sided issues and conservative management for the rib fracture. 

Case 2: A 46-year-old man with hypertension sought care for a week-long cough and left sided chest pain. While initial tests were reassuring, his persistent discomfort led to further imaging. A CT scan uncovered a left rib fracture with a small pleural effusion, likely from his cough. He received antibiotics and supportive care, highlighting the importance of thorough evaluation in patients with ongoing symptoms.

Case 3: A 26-year-old female with a 2-week history of cough and runny nose presented with chest discomfort. Chest radiography revealed multiple sternoclavicular fractures (2nd-6th right, 2nd-4th left). She was treated with pain management, discharged home, and advised to avoid heavy lifting.

Conclusion:

Cough-induced rib fractures are uncommon but important to identify early. Patients with persistent cough and acute chest pain, particularly those with risk factors, should be evaluated for this condition to prevent complications and treat underlying causes.