Sunday December 6, 2009


Q: 54 year old asian male presented to ED with cough and left sided chest pain. CXR showed pleural effusion. Radiologist call you with the result adding "there is relative enlargement of the left sided ribs". What does it imply?


Answer: Chronic pleural effusion

The most common cause is tuberculosis and require close workup and possible isolation. Changes in the ribs of patients with tuberculosis as well as the other patients with chronic effusion are due to local hyperemia from an adjacent inflammatory process. In advanced cases, the affected side of the thorax is also contracted, so gravitational and postural factors might also play a role.

Remember these rib changes are not case of direct or metastisize skeletal tuberculosis as there is no destruction of bone.



Reference: Click to get article

Rib Enlargement in Patients with Chronic Pleural Disease - AJR:167, October 1996