Kostokondral veya sternokostal ayrışma

Özet

Kostal kıkırdak ayrışması, künt göğüs travmasında kaburga-kıkırdak veya kıkırdak-sternum devamlılığının bozulmasıyla oluşur; belirgin kemik kırığı olmadan da göğüs duvarı ağrısını açıklayabilir. İnce kesitli kontrastsız toraks BT’si kostal kıkırdak kırıklarını tanımlamak ve eşlik eden kardiyopulmoner hasarı değerlendirmek için tercih edilen yöntemdir. Yaralanmayı saptamak, ön kostal halka hasarını ve eşlik eden kaburga ya da sternum kırıklarını doğru tarif etmeyi sağlar. Kostal kıkırdak kırıkları görüntülemede sıklıkla gözden kaçmakta ve bu nedenle literatürde yeterince rapor edilmemektedir.

Faz ve pencere

Kontrastsız tanısal

Kostal kıkırdak boyunca düşük atenüasyonlu çizgisel yarık, kıkırdak konturunda kesinti veya kemik kaburga/sternum ucuna göre basamaklanma aranır; yumuşak doku penceresinde komşu şişlik ve hematom eşlik edebilir.

Önerilen pencereler: Kemik (G 1800 / M 400), Yumuşak doku (G 400 / M 40), Mediasten (G 350 / M 50).

BT bulguları

• Kostal kıkırdak içinde kısmi ya da tam kat düşük atenüasyonlu yarık
• Kıkırdak dış konturunda kırık düzeyinde ani kesinti veya açılanma
• Kostal kıkırdak ucunun komşu kemik kaburga ya da sternumla devamlılığının kaybolması
• Ayrışma hattının iki yanında yumuşak doku şişliği veya küçük hematom
• Kostal kıkırdak kırığı BT'nin yumuşak doku penceresinde yer değiştirmiş olarak görülebilir.
• Kostal kıkırdak kırıklarına ön kaburga veya sternum kırıkları eşlik edebilir.
• Birden fazla komşu kıkırdak segmentinde deformite ve ön toraks duvarı konturunda asimetri

Normalde

Kostal kıkırdak kırıkları, ilgili kıkırdakta belirgin kalsifikasyon yoksa konvansiyonel grafide saptanamayabilir; BT’de yumuşak doku penceresinde yer değiştirmiş kırık olarak görülebilir.

Ayırıcı tanı

Ön kaburga kırığı

kesinti kıkırdak dokusunda değil, kemik korteksinin içinde izlenir.

Sternum kırığı

manubrium veya sternum gövdesinin kortikal çizgisi bozulur; kıkırdak ucu normal yerinde olabilir.

Fizyolojik kostal kıkırdak kalsifikasyonu

mineralizasyon biçimi değişken olabilir, fakat eşlik eden travmatik yarık ve uç uyumsuzluğu beklenmez.

Kostokondrit, kaburga ağrısının olası klinik ayırıcı tanılarındandır.

Kostal kıkırdak tümörü

kıkırdak merkezli lobüle kitle, matriks mineralizasyonu veya kemik destrüksiyonu travmatik çizgisel yarıktan ayrılır.

Tuzaklar

• İnce kıkırdak yarığı kemik algoritmasında silik kalabilir; şüpheli seviyeyi yumuşak doku penceresinde ve ardışık aksiyel kesitlerde yeniden izle.
• Kalsifikasyonun kesintili ya da asimetrik olması tek başına travma kanıtı değildir; kortikal/kıkırdak kontur bozukluğu ve çevre hematomla örtüşmesini ara.
• Kostal kıkırdak kırıklarının doğal seyri, stabil kaynama ile iyileşip iyileşmeyecekleri açısından bilinmemektedir.

Kendini dene

1. Spor çarpışması sonrası BT’de alt ön göğüs duvarında kıkırdak aralığı ve kontur basamağı görülüyor. En olası lezyon hangisidir?

   • Kostal kıkırdak ayrışması
   • Tietze sendromu
   • Sternal foramen
   • Kostal osteokondrom
   Cevabı göster

   Kostal kıkırdak ayrışması. Travma sonrası kıkırdak dokuda yarıkla birlikte kontur basamağı ayrışmayı destekler. Tietze sendromu kaynaklarda yalnızca göğüs duvarı hastalıkları arasında anılmıştır; yapısal deplasman oluşturmadığı belirtilmemiştir. Osteokondrom, kemik yüzeyinden çıkan sessil veya pedinküle büyüktür (en sık görülen benign kemik tümörü). Kaynakta BT ile tanımlanan lezyon, yer değiştirmiş kostal kıkırdak kırığıdır.

2. Kıkırdak arkında yer değiştirme var ve arkasındaki komşu kemik kaburga korteksi de kesintili. İkinci bulgu nasıl adlandırılır?

   • Ön kaburga kırığı
   • Kostokondrit
   • Sternoklaviküler artrit
   • Sternal yarık
   Cevabı göster

   Ön kaburga kırığı. Kostal kıkırdak bulgusuna ek olarak kemik korteksindeki kesinti, ayrı bir ön kaburga kırığıdır. Kostokondrit yapısal korteks kopması oluşturmaz; sternoklaviküler artrit ve sternal cleft farklı anatomik bölgelerde yer alır.

İlgili konular

• Sternum kırığı
• Sternumun normal varyantları

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 6 cümle bu karşılaştırmada düzeltildi (2026-10-09).

1. Costal cartilage fracture: A commonly missed thoracic injury in trauma patientspmc.ncbi.nlm.nih.gov
2. Benign Posttraumatic Pseudopneumoperitoneum.pubmed.ncbi.nlm.nih.gov
3. Anatomy of the tenth costal cartilage for a columella strut in an Asian rhinoplasty.pubmed.ncbi.nlm.nih.gov
4. Stepwise transversus abdominis muscle release for the treatment of complex bilateral subcostal incisional hernias.pubmed.ncbi.nlm.nih.gov
5. Hypoventilation Syndrome Secondary to Club-Shaped Chest Wall Deformity.pubmed.ncbi.nlm.nih.gov
6. Surgical reconstruction of traumatic flail chest with titanium plaques.pubmed.ncbi.nlm.nih.gov
7. Computer-Aided Design and 3D Printing to Produce a Costal Cartilage Model for Simulation of Auricular Reconstruction.pubmed.ncbi.nlm.nih.gov
8. Traumatic temporomandibular joint ankylosis: our classification and treatment experience.pubmed.ncbi.nlm.nih.gov
9. CT measured normative cartilage growth in children requiring costochondral grafting.pubmed.ncbi.nlm.nih.gov
10. Perinatal rib fractures in 18 calves delivered from Holstein dams.pubmed.ncbi.nlm.nih.gov
11. Osteomyelitis of the ribs in children: a rare and potentially challenging diagnosis.pubmed.ncbi.nlm.nih.gov
12. The costochondral length in patients with pectus excavatum is longer than that of the normal thorax.pubmed.ncbi.nlm.nih.gov
13. Salmonella Osteomyelitis Of Ribs.pubmed.ncbi.nlm.nih.gov
14. Incisional intercostal hernia with prolapse of the colon after right partial nephrectomy.pubmed.ncbi.nlm.nih.gov
15. "Buckle" rib fracture: an artifact following cardio-pulmonary resuscitation detected on postmortem CT.pubmed.ncbi.nlm.nih.gov
16. Point-of-care ultrasound (POCUS) diagnosis of rib fractures.pubmed.ncbi.nlm.nih.gov
17. Management of a Flail Chest Caused by Multiple Costosternal Fractures: A Case Report.pubmed.ncbi.nlm.nih.gov
18. Fracture Mapping in High-Energy Chest Trauma.pubmed.ncbi.nlm.nih.gov
19. Chest Wall and Diaphragmatic Injuries: Imaging Evaluation and Clinical Considerations.pubmed.ncbi.nlm.nih.gov
20. A pictorial essay of thoracic wall diseases: multiple pathologies in the same anatomical site.pubmed.ncbi.nlm.nih.gov
21. Rugby Injury Imaging.pubmed.ncbi.nlm.nih.gov
22. Biomechanics of chest wall injury: implications for surgical stabilization and failure prevention.pubmed.ncbi.nlm.nih.gov
23. Surgical management of complex non-union in chest wall instability: focus on posterior rib fractures, parasternal cartilage rupture, and costal margin injury.pubmed.ncbi.nlm.nih.gov
24. A Modern-Day Captain Charles Martell: Catastrophic Skeletal Manifestations of Primary Hyperparathyroidism.pubmed.ncbi.nlm.nih.gov
25. Premature Calcification of Costochondral Cartilage: A Scoping Review of the Literature.pubmed.ncbi.nlm.nih.gov
26. Autologous Tissue Grafts for Chin Augmentation With or Without Genioplasty: A Systematic Review.pubmed.ncbi.nlm.nih.gov
27. Accuracy and Safety of Computer-Assisted Surgery (CAS) in the Treatment of TMJ Ankylosis-Report of Several Cases and Review of the Literature.pubmed.ncbi.nlm.nih.gov
28. Treatment of Post-traumatic Facial Deformities.pubmed.ncbi.nlm.nih.gov
29. Innovative septum suspension technique with a cantilever graft for effective keystone region reconstruction.pubmed.ncbi.nlm.nih.gov
30. Video-assisted thoracoscopic surgery surgical stabilization of rib fractures: surgical technique and case report.pubmed.ncbi.nlm.nih.gov
31. Narrative review of chest wall ultrasound: a practical approach.pubmed.ncbi.nlm.nih.gov
32. Subchondral Insufficiency Fracture of the Knee Previously Diagnosed as Spontaneous Osteonecrosis: A Case Report With Histological Analysis.pubmed.ncbi.nlm.nih.gov
33. Bone aging: a paradigm of multiscale degeneration and targeted rejuvenation.pubmed.ncbi.nlm.nih.gov
34. Mechanical Overloading-Induced Nanomineral Crystal Perturbation from the Osteochondral Interface: A Potential Initiator of Osteoarthritis.pubmed.ncbi.nlm.nih.gov
35. Temporomandibular Joint Defects: Etiology and Reconstruction Strategy: A Narrative Review.pubmed.ncbi.nlm.nih.gov
36. Lung hernia: an updated narrative review.pubmed.ncbi.nlm.nih.gov
37. Medical Sports Injuries in American Football Players.pubmed.ncbi.nlm.nih.gov
38. A statistical shape model of the human sternum including cortical bone thickness.pubmed.ncbi.nlm.nih.gov
39. Retrospective Review Is the Best View: A Primer for Residents and Radiologists on Missed Findings in Chest Radiography.pubmed.ncbi.nlm.nih.gov
40. Magnetic resonance imaging evaluation of oblique injuries: Introduction of the deadrise sign.pubmed.ncbi.nlm.nih.gov
41. An integrated digital-to-surgical framework for patient-specific chest wall resection and reconstruction using 3D-printed titanium implants: proof-of-concept study.pubmed.ncbi.nlm.nih.gov
42. Non-neoplastic pathology at the crossroads between neck imaging and cardiothoracic imaging.pubmed.ncbi.nlm.nih.gov
43. Evolution of temporomandibular joint reconstruction: from autologous tissue transplantation to alloplastic joint replacement.pubmed.ncbi.nlm.nih.gov
44. Pathology findings and correlation with body condition index in stranded killer whales (Orcinus orca) in the northeastern Pacific and Hawaii from 2004 to 2013.pubmed.ncbi.nlm.nih.gov
45. Bone metastases from hepatocellular carcinoma: Guidance on the management of spinal and long bone lesions.pubmed.ncbi.nlm.nih.gov
46. Unconventional auricular reconstruction using controlled scaffold buckling and chondrogenic cocktail containing muscle-derived cells.pubmed.ncbi.nlm.nih.gov
47. Ultrasound superiority in detecting micro rib lesions for post-coronavirus disease 2019 chest wall pain: a comparative retrospective study.pubmed.ncbi.nlm.nih.gov
48. Insights into vitamin C in musculoskeletal physiology and disorders: mechanisms and translational perspectives.pubmed.ncbi.nlm.nih.gov
49. CHEST PAIN DUE TO A GIANT THYMOMA IN AN ADOLESCENT BOY.pubmed.ncbi.nlm.nih.gov
50. The most common bone tumors of the upper extremity in childhood and adolescence and their treatment: a review of the current literature.pubmed.ncbi.nlm.nih.gov
51. Complex anterior chest wall reconstruction after extensive oncologic resections: a narrative review.pubmed.ncbi.nlm.nih.gov
52. Osteochondromas: An Updated Review of Epidemiology, Pathogenesis, Clinical Presentation, Radiological Features and Treatment Options.pubmed.ncbi.nlm.nih.gov
53. Plastinated sectional anatomy applied in CT and MRI studies of the body of the crab-eating fox (Cerdocyon thous).pubmed.ncbi.nlm.nih.gov
54. A case of tracheobronchomegaly misdiagnosed as COPD: case report and literature review.pubmed.ncbi.nlm.nih.gov
55. Review of imaging modalities and radiological findings of calvarial lesions.pubmed.ncbi.nlm.nih.gov
56. Unlocking the potential of exosomes: a breakthrough in the theranosis of degenerative orthopaedic diseases.pubmed.ncbi.nlm.nih.gov
57. Pediatric emergency medicine point-of-care ultrasound: summary of the evidence.pubmed.ncbi.nlm.nih.gov
58. Pediatric Coronoid-Deficient Elbow Reconstruction with Iliac Crest Allograft: A Case Report.pubmed.ncbi.nlm.nih.gov
59. Concurrent histological lesions and molecular detection of porcine circovirus 3 in pigs with skeletal abnormalities and humpy-back posture.pubmed.ncbi.nlm.nih.gov
60. Debilitating Musculoskeletal Disease in Two Free-Ranging Juvenile American Black Bears ( Ursus americanus ).pubmed.ncbi.nlm.nih.gov
61. High-Grade Chondrosarcoma Involving the Xiphoid Process and Lower Sternum-The Continuing Role of Extended Open Chest Wall Surgery in the Era of Minimally Invasive Thoracic Surgery: A Case Report.pubmed.ncbi.nlm.nih.gov
62. Congenital Chest Wall Deformities in Children: A Narrative Review.pubmed.ncbi.nlm.nih.gov
63. Integration of detection and tracking networks for automated rib multiplanar reconstruction: a feasibility study for fracture diagnosis.pubmed.ncbi.nlm.nih.gov
64. Congenital Scoliosis: A Comprehensive Review of Diagnosis, Management, and Surgical Decision-Making in Pediatric Spinal Deformity-An Expanded Narrative Review.pubmed.ncbi.nlm.nih.gov
65. Association of Chiropractic Colleges Educational Conference and Research Agenda Conference 2026: Connected Care.pubmed.ncbi.nlm.nih.gov
66. Principles Underlying Surgical Decision-Making in Lowest-Instrumented Vertebra Level Selection of Adolescent Idiopathic Scoliosis: From Traditional Landmarks to Emerging Predictive Models-A Narrative Review.pubmed.ncbi.nlm.nih.gov
67. CT-based application of the Iscan method on isolated ribs: reliability, accuracy, and the role of joint fossa sclerosis in age estimation on a contemporary European skeletal sample.pubmed.ncbi.nlm.nih.gov
68. Fatal Injuries Caused by Falling Trees: Correlation Between Postmortem Computed Tomography and Forensic Autopsy Findings in Eight Cases.pubmed.ncbi.nlm.nih.gov
69. Aortic Pseudoaneurysm Mimicking a Pulmonary Neoplasm in an 87-Year-Old Patient: The Challenge of the "Great Mimicker" in Emergency Medicine.pubmed.ncbi.nlm.nih.gov
70. Hidden in Plain Sight: Unmasking a Pseudoaneurysm Without Contrast.pubmed.ncbi.nlm.nih.gov
71. Ultrasound and bone: a pictorial review.pubmed.ncbi.nlm.nih.gov
72. Nonproliferative and Proliferative Lesions of the Rat and Mouse Skeletal Tissues (Bones, Joints, and Teeth).pubmed.ncbi.nlm.nih.gov
73. Determination of cystathionine beta-synthase activity in human plasma by LC-MS/MS: potential use in diagnosis of CBS deficiency.pubmed.ncbi.nlm.nih.gov
74. The sternum in detail: a review of the anatomy and pathologies of the sternum.pubmed.ncbi.nlm.nih.gov
75. Retinal vasculitis with Chronic Recurrent Multifocal Osteomyelitis: a case report and review of the literature.pubmed.ncbi.nlm.nih.gov
76. Osteoarticular Mycoses.pubmed.ncbi.nlm.nih.gov
77. Fleischner Society: Glossary of Terms for Thoracic Imaging.pubmed.ncbi.nlm.nih.gov
78. Three-dimensional scanning with dual-source computed tomography in patients with acute skeletal trauma.pubmed.ncbi.nlm.nih.gov
79. Pediatric Desmoplastic Fibroma of the Jaws: A Comprehensive Review of Clinical Presentation, Management, and Outcomes.pubmed.ncbi.nlm.nih.gov
80. Surgical Repair of Morgagni Hernia With Liver Herniation and Rib Fractures in an Adult Following Rhinovirus-induced Coughing.pubmed.ncbi.nlm.nih.gov
81. Evidence for deliberate burial of the dead by <i>Homo naledi</i>.pubmed.ncbi.nlm.nih.gov
82. Aberrant rib cage anatomy with false ribs attachment to the sternum: review of the literature focused on slipping ribs syndrome case reports.pubmed.ncbi.nlm.nih.gov
83. Aggressive Mesenchymal Chondrosarcoma of the Rib With Early Skeletal Metastases: A Diagnostic Challenge.pubmed.ncbi.nlm.nih.gov
84. Dextrocardia in Heterotaxy Syndrome (Polysplenia Variant) in a 36-Year-Old Ethiopian Woman: A Case Report and Literature Review.pubmed.ncbi.nlm.nih.gov
85. Septic Arthritis of the Manubriosternal Joint in an Immunocompetent Adult: A Case Report.pubmed.ncbi.nlm.nih.gov
86. Case Report: Cardiac angiosarcoma with rib pain as the first symptom.pubmed.ncbi.nlm.nih.gov
87. Radiation-induced osteoradionecrosis of the ribs in a patient with breast cancer: A case report.pubmed.ncbi.nlm.nih.gov
88. Detection of Costal Cartilage Fractures on CT Images With Computer-aided Detection System for Rib Fractures.pubmed.ncbi.nlm.nih.gov
89. Surgical stabilization of rib fractures (SSRF): the WSES and CWIS position paper.pubmed.ncbi.nlm.nih.gov
90. Left fourth and sixth costovertebral dislocation abutting the aorta.pubmed.ncbi.nlm.nih.gov
91. Current clinical and translational challenges in temporomandibular joint reconstruction.pubmed.ncbi.nlm.nih.gov
92. Verification and optimization of impact-response consistency in human thoracic targets for blunt ballistic impact testing.pubmed.ncbi.nlm.nih.gov
93. Age-related outcomes of minimally invasive repair of pectus excavatum: a single-center retrospective cohort study.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.