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Case Reports
. 2024 Jan;53(1):187-192.
doi: 10.1007/s00256-023-04415-3. Epub 2023 Jul 31.

Left fourth and sixth costovertebral dislocation abutting the aorta

Natalia Gorelik  1 , Dany Croteau  2 , Valérie Gorelik  3 , Joseph Casullo  4
Affiliations
Case Reports

Left fourth and sixth costovertebral dislocation abutting the aorta

Natalia Gorelik et al. Skeletal Radiol. 2024 Jan.

Abstract

While rib fractures are common in blunt thoracic trauma, dislocations of the costovertebral joints (CVJs) are extremely rare and typically involve the first, eleventh, or twelfth rib. We report a rare case of dislocation of the left fourth and sixth CVJs in a 36-year-old man who was run over by a car. The rib heads were displaced anteriorly, abutting the aorta. Additional injuries included bilateral hemopneumothoraces, pneumomediastinum, pulmonary contusions, grade 3 splenic injury, left adrenal hematoma, retroperitoneal hematoma, Morel-Lavallée lesions at bilateral hips, and multiple fractures, including at the ribs and pelvis. There was also a fracture of the fourth thoracic vertebral body, which was occult on initial CT, but seen on subsequent CTs. The CVJ dislocations were managed conservatively, without short-term complications. Prompt surgical intervention has been recommended in cases where sharp rib fracture fragments are displaced close to the aorta to prevent fatal aortic injuries. However, there is a literature gap on the management of rib heads that are dislocated against the aorta. Our experience suggests that conservative management may be acceptable in some of these cases. This case report aims to increase radiologists' awareness of CVJ injuries, which are important for thoracic spine stability, and highlights the association between CVJ dislocations and spinal injuries.

Keywords: Aorta; Costovertebral joint; Dislocation; Spine; Trauma.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Initial post-trauma CT in 36-year-old male who was run over by a car, with axial (a) and sagittal (c) images demonstrating a left fourth costovertebral joint dislocation, and axial (b) and sagittal (d) images showing a left sixth costovertebral joint subluxation, with the heads of the ribs abutting the aorta (arrows)
Fig. 2
Fig. 2
Illustration of the costovertebral joint anatomy, including the costotransverse joint and the costocentral joint (also known as joint of head of rib), at the level of the T7 and T8 vertebrae. Reprinted with permission from Hombach-Klonisch S, Klonisch T, Peeler J. Thorax. In: Hombach-Klonisch SK, Thomas., Peeler J, editors. Sobotta Clinical Atlas of Human Anatomy. 1 ed. Germany: Elsevier; 2019. p. 223-80, Figure 5.21
See this image and copyright information in PMC

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