# Minor Trauma, Major Discovery: The Ultrasound Identification of a Sternal Fracture Missed by Computed Tomography in an Older Patient Presenting With Acute Chest Pain

## TL;DR

A 96-year-old woman with chest pain after minor trauma had a sternal fracture missed by CT but detected by ultrasound, highlighting ultrasound's value in diagnosing subtle injuries in older patients.

## Contribution

Demonstrates ultrasound's effectiveness in detecting sternal fractures missed by conventional imaging in geriatric trauma cases.

## Key findings

- Chest radiography and CT failed to detect a sternal fracture in an elderly patient.
- Ultrasound successfully identified the sternal fracture, emphasizing its diagnostic utility.
- The case advocates for considering sternal fractures in older patients with minor trauma and atypical chest pain.

## Abstract

This case report presents the diagnostic difficulties encountered by a 96-year-old woman with osteoporosis who experienced acute chest pain following minor trauma, eventually diagnosed with a sternal fracture. It highlights the nuanced presentation and diagnostic challenges associated with sternal fractures in older patients. Despite the prevalent use of chest radiography and computed tomography in acute trauma assessments, this case emphasizes their limitations, as both modalities initially failed to detect the sternal fracture. The successful identification of the fracture using ultrasound (US) underscores the utility of this modality in detecting subtle yet clinically significant injuries. This report advocates for a high index of suspicion for sternal fractures in older patients presenting with chest pain after minor trauma and suggests that US is a valuable, less invasive diagnostic tool. By illuminating the potential for minor trauma to cause major injury and the critical role of US in diagnosis, this case provides valuable insights into the management of sternal fractures in the geriatric population, urging clinicians to consider atypical presentations in diagnostic evaluations.