Detection of Sternum Fracture with POCUS Despite Normal Computed Tomography Findings: A Case Report

Abstract

Sternal fractures are extremely rare in children. It often develops after high-energy chest trauma. Many methods other than ultrasonography are used in the diagnosis of sternal fractures. However, Point-of-care ultrasound (POCUS) can outperform other methods due to its ease of use, less radiation and fast results. A thirteen-year-old male patient was brought due to chest pain that started after blunt chest trauma after falling from a height. In her initial evaluation in the trauma room, the patient's respiratory and cardiovascular examinations were found to be normal. On palpation, there was local tenderness in the middle 1/3 of the sternum. No pathology was detected in E-FAST. The portable chest radiograph was normal. POCUS was performed after the patient did not respond to analgesic treatment and had local sensitivity on the sternum. A sternal fracture was detected. Suspicious cortical irregularity was detected in repeated chest X-ray and thorax CT was reported as normal. When CT was re-evaluated, a wet tree fracture was observed in the sternum body. The patient was discharged without any complications. In this article, the importance of diagnosing a sternal fracture case whose computed tomography was reported as normal with POCUS and integrating rapid, noninvasive and radiation-free ultrasonography into the physical examination will be discussed in the management of these patients.