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Case Reports
. 2023 Oct 7;18(12):4435-4438.
doi: 10.1016/j.radcr.2023.09.029. eCollection 2023 Dec.

Sternal stress fracture presenting as acute chest pain

Chiew-Jen Ong  1 , Talal Mourad  2 , Parker Weiss  3 , Ryan Martin  1 , Grace Palaparty  1 , Emad Allam  1
Affiliations
Case Reports

Sternal stress fracture presenting as acute chest pain

Chiew-Jen Ong et al. Radiol Case Rep. .

Abstract

Sternal fractures are rare and are typically caused by major trauma such as motor vehicle collisions. However, sternal insufficiency fractures can occur with minimal to no trauma in patients with exaggerated thoracic kyphosis from multiple thoracic compression fractures, especially in the setting of osteoporosis. We describe a case of a sternal insufficiency fracture that presented as chest pain resembling a myocardial infarction. As sternal insufficiency fractures may vary in clinical presentation, this case demonstrates that radiologists should carefully evaluate the sternum, especially when risk factors are present. Furthermore, awareness and identification of these fractures can prevent unnecessary cardiac workups.

Keywords: Chest pain; Compression fracture; Insufficiency fracture; Sternal fracture; Stress fracture; Thoracic kyphosis.

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Figures

Fig 1
Fig. 1
(A) PA radiograph of the chest shows no acute pulmonary abnormality. (B) Lateral radiograph of the chest also shows no acute pulmonary abnormality. Exaggerated thoracic kyphosis and multiple thoracic compression fractures are seen. There is subtle cortical offset at the posterior margin of the sternum (arrow). (C) Magnified view of lateral radiograph of the chest confirms cortical step-off at the posterior margin of the sternum (arrow). This is concerning for a nondisplaced sternal fracture.
Fig 2
Fig. 2
(A) Sagittal CT image of the chest with bone windows shows multiple thoracic compression fractures. These were chronic when compared to prior imaging. There is irregularity of the posterior margin of the sternum. (B) Sagittal CT image of the chest with attention to the sternum shows subtle cortical step-off at the posterior margin of the sternum, consistent with a nondisplaced fracture (arrow).
Fig 3
Fig. 3
Follow-up lateral radiograph of the sternum shows increased displacement of the sternal fracture (arrow). This radiograph was obtained 2 weeks after the chest radiographs in Fig. 1.
See this image and copyright information in PMC

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