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Weekly Chest CasesArchive of Old Cases

Case No : 906 Date 2015-03-09

  • Courtesy of Sung Ho Hwang, Soo-Youn Ham, Yu-Whan Oh / Korea University Anam Hospital
  • Age/Sex 45 / M
  • Chief ComplaintPain in the right anterior chest wall
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Sternocostoclavicular Hyperostosis
Radiologic Findings
Chest radiograph (Fig.1) shows asymmetric opacities with hyperostosis of the sternum and anterior portion of the right first rib. Chest CT images (Figs. 2 and 3) show hyperostosis in the sternum, right clavicle, first rib, and manubrium.
Brief Review
In its classic form, sternocostoclavicular hyperostosis is characterized by distinctive bone overgrowth and soft tissue ossification of the clavicle, and anterior portion of the upper ribs, and sternum. Patients are usually in the fourth to sixth decades of life. Bilateral alterations predominate. Clinical findings include pain, swelling, and tenderness in the anterior upper chest. Osseous overgrowth may lead to occlusion of the subclavian veins. Approximately one half of patients have acne or pustular lesions with the best described association being with palmoplantar pustulosis. The term SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) represents this spectrum of inflammatory bone disorders that is associated with dermatologic pathology.The diagnosis of sternocostoclavicular hyperostosis can be applied most confidently to an illness of adults in which bone hypertrophy and ligamentous ossification involve the structures of the anterior chest wall and in which other features, including pustular skin lesions, spinal and tubular bone involvement, and subclavian venous obstruction, may or may not be present.
Please refer to
Case 291, Case 890,
References
1. Kohler H. From Sternocostoclavicular Hyperostosis (SCCH) to SAPHO syndrome. Curr Rheumatol Rev. 2013;9(1):15-6.
2. Jung J, Molinger M, Kohn D, et al. Intra-articular glucocorticosteroid injection into sternocostoclavicular joints in patients with SAPHO syndrome. Semin Arthritis Rheum. 2012 Dec;42(3):266-70.
Keywords
Chest wall, Others,

No. of Applicants : 109

▶ Correct Answer : 64/109,  58.7%
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Chonnam National University Hospital , Korea (South) So yeon Ki
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - Pusan National University Yangan Hospital , Korea (South) yoonyoung choi
  • - CHRU Lille , France Jeremy Hanckowiak
  • - Avrasya Hospital , Turkey Murat Ulusoy
  • - Seoul university hospital , Korea (South) Youngjin Ryu
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - Asan medical center , Korea (South) Sang Young Oh
  • - Isfahan University Of Medical Sciences , Iran johary s
  • - 媛€ , Korea (South) Jo Yeseul
  • - University of British Columbia , Canada Amr Ajlan
  • - MBAL BURGAS , Bulgaria VLADISLAV RUSINOV
  • - Chonnam National University Hwasun Hospital , Korea (South) Yunhong Yoon
  • - Kyung Hee University Hostpital at Gangdong , Korea (South) Jun-Hyung Lee
  • - DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
  • - Freelance resident in Reunion Island , Reunion Fabien HO
  • - �stanbul , Turkey Ayhan Yilmaz
  • - Daejin Medical Center Bundang Jesaeng General Hospital , Korea (South) Donghwan Kim
  • - Ajou University hospital , Korea (South) Hun Cho
  • - Okinawa Kyodo Hospital , Japan Shoko Iraha
  • - CHRU Lille , France Julien Pagniez
  • - National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
  • - Pusan national university hostpital , Korea (South) hyunjung kang
  • - Pusan national university hospital , Korea (South) Hie Bum Suh
  • - Pusan national university of hospital , Korea (South) Jo ji eun
  • - GMC & Sir JJ Hospital, Mumbai, India. , India Gaurav Watane
  • - Asan Medical Center , Korea (South) Jooae Choe
  • - Pusan national university hospital , Korea (South) SeungHyun Lee
  • - Pusan national university hospital , Korea (South) Minkyu Kwak
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - UZA , Belgium Eline De Smet
  • - Bahcesehir University School of Medicine, Radiology Department , Turkey Mustafa Kemal Demir
  • - PNUH , Korea (South) Seungbaek Hong
  • - University of Tsukuba Hospital , Japan Sodai Hoshiai
  • - Seoul National University Hospital , Korea (South) Hyoung-In Choi
  • - Asan Medical Center , Korea (South) Soyeoun Lim
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Asan Medical Center , Korea (South) Hyung Jung Koo
  • - CHU Poitiers , France CHAN paul
  • - Busan national univercity hospital radiology department , Korea (South) Il-wan Son
  • - 異⑸ , Korea (South) Yunhee Jang
  • - Dong-A University Hospital , Korea (South) Won Jin Choi
  • - Nagasaki University Hospital, Department of Pathology , Japan TOMONORI TANAKA
  • - Chungbuk national university , Korea (South) Yong Kim
  • - Myongji hospital , Korea (South) Ji Ye Lee
  • - IRSA La Rochelle , France Denis Chabassiere
  • - 異⑸ , Korea (South) Junghwan Kim
  • - VHS medical center , Korea (South) Keuntak Roh
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - CARE HOSPITAL , India shakti satapathy
  • - Kobe City Medical Center General Hospital , Japan Yasuhisa Kurata
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - Seoul National University Hospital , Korea (South) Sunkyung Jeon
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - All India Institute of medical sciences , India Justin Moses
  • - Medicheck health care , Korea (South) Chae Lim
  • - Kyungbook National University Hospital , Korea (South) Chu Yun ju
  • - CNUH , Korea (South) Noh Hoon
▶ Correct Answer as Differential Diagnosis : 6/109,  5.5%
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - the University of Tokyo , Japan Eisuke Shibata
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - SNUH , Korea (South) Eui Jin Hwang
  • - SQUH , Oman Saleh Baawain
▶ Semi-Correct Answer : 31/109,  28.4%
  • - university of montreal , Canada Andrei Gorgos I
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Samsung medical center , Korea (South) Hyun Su Kim
  • - Kyoto University , Japan Akihiko Sakata
  • - iran university , Iran Mohammad reza Ayoubpour
  • - Haeundae Paik Hospital , Korea (South)
  • - pusan national university hospital , Korea (South) jiwon lee
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - Pamukkale University, Faculty of Medicine, Dept. of Radiology , Turkey Furkan Ufuk
  • - Chonbuk National University Hospital , Korea (South) Eunyoung Kim
  • - University of the Ryukyus , Japan Nanae Tsuchiya
  • - Otsu Red Cross Hospital , Japan Hirotsugu Nakai
  • - Pusan national university hospital , Korea (South) So Park
  • - Niigata University , Japan Atsushi Uehara
  • - Northern Yokohama Showa university , Japan Kota Watanabe
  • - santosh hospital , India Pravin Mahadevappa
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - CH de la C�e Basque , France Paul ARDILOUZE
  • - Eulji Hospital Eulji University , Korea (South) Min Sun Jeong
  • - Kyungpook National Univ. Hospital , Korea (South) Park jongmin
  • - chp st martin , France Mariotte benoit
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - Gifu Central Hospital , Japan Haruo Watanabe
  • - NASA SCANS , India RAKESH BHATIA
  • - CLCC Rennes , France nicolas gautier
  • - Pusan national university hospital , Korea (South) Jin Joo Kim
  • - Ibaraki-gazou-shindan , Japan Shoichi Katoh
  • - , Korea (South) Chan Park
  • - CNUH , Korea (South) LEE EUN
  • - Wuhan Union Hospital , China Qiguang Cheng
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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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