This was a 25 year old lady who fell on her chest while a cow was chasing her . She had persistent severe pain in the left side of the chest. Xray of the rib cage was reported as normal and appeared to be normal.
Scan over the point of maximal tenderness ( over the 6th rib on the left side anteriorly) revealed a crack in the bone on the posterior aspect . Probably as it was not a complete fracture it was missed on the xray.
The images are shown below
The patient was referred to the orthopedic surgeon for further management.
These images are presented to illustrate the need to look beyond conventional thinking and the extended use of ultrasound .