Spontaneous Rib Fractures Secondary to Severe Coughing in a Patient with Chronic Obstructive Pulmonary Disease: a Case Report and Diagnostic Considerations

Abstract

Purpose: Spontaneous rib fractures following intense coughing are uncommon, particularly without osteoporosis. Chronic obstructive pulmonary disease (COPD) patients face increased fracture risk due to chronic inflammation, persistent coughing, and altered thoracic biomechanics. Methods: A 47-year-old male with 10-year COPD history presented with acute left posterior chest/back pain after forceful coughing. Physical examination revealed localized tenderness. Initial chest radiography was negative. Non-contrast thoracic CT (supine, breath-hold; evaluated by two radiologists) was performed due to persistent pain. Findings: CT identified nondisplaced fractures of the left seventh/eighth posterior ribs. Analgesics (ibuprofen 600mg every 8hrs) reduced pain from 8/10 to 3/10 on the Numerical Rating Scale. No bone density assessment was conducted. Conclusion: Rib fractures may occur spontaneously in COPD patients without trauma or osteoporosis and are frequently missed by radiography. CT is essential for diagnosis. COPD itself constitutes a biomechanical risk factor, warranting preventive strategies (bone density screening, cough management) in high-risk individuals.