Flail Chest

A consequence of acute chest trauma.

Pathogenesis: Several consecutive ribs are fractured in multiple locations such that a sizeable area of the chest wall is dissociated from the normal thoracic chest wall movement that occurs during respiration. The dissociated area moves paradoxically, effectively impedes lung inflation and deflation and also increases the compliance of the involved lung.  This may lead to hypoxemia and if severe enough, respiratory failure or collapse.

CXR Findings:  Multiple rib fractures at multiple sites.

Common Associated Findings: pneumothorax, subcutaneous emphysema, hemothorax

Other Associated Thoracic Findings: this injury indicates severe chest trauma and trauma to the aorta, trachea, and bronchi should be looked for.

Follow-up: Look for associated potentially fatal thoracic trauma. A CT of the chest with an aortic protocol may be needed in these patients.

“Aunt Sophies”: multiple rib fractures without the chest wall detachment process needed for the “flail chest syndrome”