Chest injury

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Submitted by Dr T on August 16, 2011 – 1:57pm

I am a bull rider and recently got hit on the left side of my ribs, since then everytime i lay on my back my heart beats abnormally and makes a loud click or gurgle type of sound. i am wondering what this could be. it only happens when laying on my back. i can lay on my stomach or side and it will be fine.

You have sustained an injury that needs to be examined, but there are too many options about what could have happened for me to guess. A collapsed lung (pneumothorax), rib fractures & a Flail Chest come to mind as well as injuries to your diaphragm and pericardium (heart sack). Since you were hit on your left side, your heart wasn’t far away! A pneumothorax would have produced significant shortness of breath as well as other symptoms, and is therefore unlikely in your case:

Left sided pneumothorax, lung partially collapsed.

While many chest injuries will require no specific therapy, they may indicate an injury to the nearby lungs, heart and diaphragm. Multiple rib fractures are often associated with an underlying pulmonary or even cardiac contusion:

Left sided lung contusion.  Chest tube inserted to treat a pneumothorax. Once the lung was re-expanded, the contusion became apparent.

A flail chest occurs when at least two fractures per rib (producing a free segment) are broken:


Video of a flail chest.

I recommend you see your doctor, get a Chest X ray, and depending on what is found, a CT scan of your chest, and probably a cardiac echo if your heart appears involved. Treatment of course will depend on what is found.

Hope this helps,
Dr T

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