Recent papers by Cohen,1 Mitchell,2 and Wynn-Williams3 have called attention to rib fractures caused by coughing associated either with pulmonary tuberculosis or with no apparent pulmonary disease. This condition appears to be much commoner than is generally recognized. It would probably be diagnosed more frequently if suitable x-ray pictures, especially anterior oblique views, were taken of patients with complaints of sudden pain in the chest made worse on inspiration, sometimes following unusual exertion or a cough. Pains formerly dismissed as "muscle tears" in the thorax may well be unsuspected fractures of the ribs, especially of those of the lower thoracic cage.
Paulley, Lees, and Pearson4 have reviewed the literature on cough fractures of ribs, especially those occurring in late pregnancy. Paulley5 later mentioned four more rib fractures in pregnant women, stressing that they were all on the left side and affected the lower ribs. Chesney
Marsh K. STRESS FRACTURES OF RIBS IN SUCCESSIVE PREGNANCIES. JAMA. 1953;152(1):26-27. doi:10.1001/jama.1953.63690010002007a