fractures from chronic coughing tend to affect the lateral and middle aspects of the rib cage , with a marked female majority . the muscular strain of repetitive coughing causes an internal force , as opposed to an external force from trauma . the subsequent chronic muscular strain from the internal force upon the rib can potentially cause a we report a case of an elderly woman who sustained an isolated , undisplaced pelvic fracture of the left ilium following a severe coughing fit . investigations revealed this to be pathological in nature , secondary to metastatic deposits within bone . an eighty - year old woman presented to the emergency department with an inability to mobilize following an acute episode of coughing . she describes hearing a loud crunch originating from the left hip at the time of coughing . there was no history of trauma and the patient had been previously mobilizing independently . of note she was a heavy smoker , suffered from peripheral vascular and chronic obstructive pulmonary disease . the patient had had significant weight loss of thirteen kilograms over a six - month period associated with epigastric pain . this had been extensively investigated prior to presentation , with oesophago - gastro duodenoscopy ( ogd ) , chest radiographs and computerized tomography ( ct ) thorax and abdomen . the patient could not straight leg raise , but there was good passive movement of her left leg . plain radiographs demonstrated an undisplaced , fracture of the left ilial wing with suspicion of metastatic deposits around the fracture site ( see fig . further imaging , with magnetic resonance was obtained and revealed multiple focal abnormalities of the pelvis and femur with vertebral collapse at t7 and l1 ( see fig . ct thorax identified a right hilar lung mass with multiple metastases to the ribs , t9 , l1 , pelvis and liver ( see fig . it was unclear whether there were two synchronous primary malignancies of the stomach and lung , with secondary metastasis ; or there was a single lung primary with metastases to liver , stomach and bone . these can be of non - neoplastic origin , stress fractures occurring in osteoporotic bone , or neoplastic , as a result of primary or secondary deposits causing weakened areas in bone that are amenable to fracture with minimal trauma . these have been well documented , but the rarity of this case lies with the unusual mechanism of injury . coughing can generate forces of up to 25  joules of energy , however it is usually insufficient to result in pelvic fractures within normal bone . despite this patient having being investigated extensively for a presumed neoplasm the results of which , at the time were inconclusive , she presented six - months later with lung cancer and gross metastasis to the stomach , liver and bone , not amenable for active treatment . this case highlights the importance of considering sinister causes in patients presenting with non - traumatic pelvic fractures and the need for regular follow up for those patients investigated with unexplained weight - loss with inconclusive results , but with a high index of suspicion for malignancy . manpreet sidhu  writing up the abstract , introduction , case report , discussion and conclusion .
highlightscase report of 80y sustaining pathological pelvic fracture after coughing.patient had been investigated extensively 6 months before for weight loss.all results were inconclusive.further investigations reveal synchronous primary malignancies of the stomach and lung.recommend regular follow up for patients investigated with unexplained weight - loss with inconclusive results , but with a high index of suspicion for malignancy .