Bilateral Multiple Rib Fractures and Hump-Like Shadows on Chest Roentgenogram

  • Keisuke Maeda JCHO Hokkaido Hospital
  • Masashi Ohe JCHO Hokkaido Hospital
  • Haruki Shida JCHO Hokkaido Hospital
  • Tetsuya Horita JCHO Hokkaido Hospital
  • Ken Furuya JCHO Hokkaido Hospital
Keywords: Rheumatoid arthritis, osteoporosis, rib fractures


A 58-year-old female with rheumatoid arthritis (RA), osteoarthritis of the bilateral knees, thoracic vertebral compression fractures, steroid-induced osteoporosis, and immune thrombocytopenia (ITP) presented with bilateral side chest pain. She had been treated with prednisolone for RA and ITP for 10 years. On her current visit, a chest roentgenogram revealed bilateral rib fractures and hump-like shadows. A chest computed tomography scan revealed multiple rib fractures accompanied by hematoma that pressed fractured ribs into the bilateral lungs. Regarding abnormal shadows on the chest roentgenogram, blood discharge from the fractured ribs formed the hematoma, causing the hump-like shadows

Author Biographies

Keisuke Maeda, JCHO Hokkaido Hospital
Department of Internal Medicine
Masashi Ohe, JCHO Hokkaido Hospital
Department of Internal Medicine
Haruki Shida, JCHO Hokkaido Hospital
Department of Internal Medicine
Tetsuya Horita, JCHO Hokkaido Hospital
Department of Internal Medicine
Ken Furuya, JCHO Hokkaido Hospital
Department of Internal Medicine


Sung YK: Risk fractures of osteoporosis in rheumatoid arthritis patients. Glucocorticoid, inactivity, or nutrient deficiencies. J Rheum Dis 2017;24:63-4.

El Maghraoui A, Rezqi A, Mounach A, Achemlal L, Bezza A, Ghozlani I. Prevalence and risk factors of vertebral fractures in women with rheumatoid arthritis using vertebral fracture assessment. Rheumatology (Oxford) 2010;49:1303-10.

Jun DS, An BK, Yu CH, Hwang KH, Paik JW. Practical use of bone scan in patients with an osteoporotic vertebral compression fracture. J Korean Med Sci 2015;30:194-8.

Barrett-Connor E, Nielson CM, Orwoll E, Bauer DC, Cauley JA. Epidemiology of rib fractures in older men: Osteoporotic Fractures in Men (MrOS) prospective cohort study BMJ 2010;340:c1069.

Original Image