Rib Fracture Missed on Chest X-ray: How Point of Care Ultrasound Changed Management After a Skiing Fall

A 51-year-old male presented to urgent care after falling while spring skiing. He reported catching an edge, pitching forward, and landing forcefully onto his left anterior chest. He immediately experienced localized pain, worsened by deep inspiration. He denied shortness of breath, syncope, and head or neck injury.

Vital signs were normal. Examination demonstrated focal tenderness over the left anterior chest wall at the level of the fourth rib without visible ecchymosis, crepitus, or deformity. Lung sounds were clear and equal bilaterally.

A chest X-ray showed no acute bony abnormality and no pneumothorax. Due to persistent focal pain, point-of-care ultrasound (POCUS) was performed over the area of maximal tenderness.