EpistemisPost-traumatic pleuritic localized rib pain
Specialty: Respiratory.
Why it occurs
- Single or multiple consecutive rib fracture secondary to direct thoracic trauma (the fractured bone fragment directly irritates the adjacent parietal pleura with each respiratory movement, generating exquisite localized stabbing pain over the affected rib that is severely exacerbated with deep inspiration, cough, and active mobilization of the trunk)
- Pulmonary contusion with localized reactive pleuritis secondary to costal bone trauma.
Initial workup
Chest x-ray (PA, lateral and costal oblique projections); Pleuropulmonary ultrasound at the bedside (very sensitive to detect small rib fractures and pneumothorax immediately); Computed tomography (CT) of the chest with bone and parenchyma window; Analytical arterial blood gas.
red flags
Presence of paradoxical abdominal or thoracic breathing (suggestive of flail chest or rib volet), rapidly progressive dyspnea, cyanosis, frank hemoptysis, or crepitant subcutaneous emphysema on palpation of the chest wall (suggestive of associated traumatic pneumothorax).
Standard management
- Dexketoprofen — 25 mg orally every 8 hours, or 50 mg intravenously every 8-12 hours as an anti-inflammatory analgesic with excellent bone and pleural penetration
- Paracetamol — 1 g intravenous every 8 hours combined
- 5% Lidocaine skin patch (applied locally to the painful area for a maximum of 12 hours a day, monitoring skin integrity).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Respiratory
- Listed causes
- 2
- Treatment options
- 3