대한흉부영상의학회 Weekly Chest Cases

Case No : 291 Date 2003-05-24

Courtesy of Hyun Ju Lee, M.D., Jin Mo Goo, M.D., Jung-Gi Im, M.D. / Seoul National University Hospital, Seoul, Korea
Age/Sex 48 / M
Chief ComplaintIntermittent swelling, tenderness, and pain on left upper chest wall

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Diagnosis With Brief Discussion

Diagnosis: Sternocostoclavicular Hyperostosis
Radiologic Findings: Chest PA (Figs 1) shows bony sclerosis and overgrowth in bilateral clavicles and upper ribs. Bone window setting of the chest CT scans (Fig 2-3) show mixed sclerotic and osteolytic change and swelling of the sternum, bilateral clavicles and ribs. Bone scan with technetium 99m methylene diphosphonate (Tc99m-MDP) (Figs 4) shows increased uptake in the sternum, bilateral clavicles and ribs.
Brief Review: The classic form of sternocostoclavicular hyperostosis is characterized by distinctive bone overgrowth and soft tissue ossification of the clavicle, anterior portion of the upper ribs, and sternum. Patients usually are in the fourth to sixth decades of life. Men are affected more frequently than women. Bilateral symmetrical involvements predominate.
Clinical findings include pain, swelling, tenderness, and local heat in the anterior upper chest. Bony overgrowth may lead to occlusion of the subclavian veins. Approximately 30 to 50 percent of patients with sternocostoclavicular hyperostosis reveal evidence of pustulosis palmaris et plantaris. The sternocostoclavicular hyperostosis reveals a protracted course with periods of exacerbation and remission.
The major radiographic abnormalities of sternocostoclavicular hyperostosis are seen in the anterior and upper portion of the chest wall. Hyperostosis of the sternum, clavicle, and upper ribs is encountered. Additional changes occur in the vertebral column and include spinal outgrowths that resemble those of ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, or psoriatic spondylitis.
The diagnosis of sternocostoclavicular hyperostosis can be applied most confidently to an illness of adults in which bone hypertrophy and ligamentous ossification involves the structures of the anterior chest wall. Other features, including pustular skin lesions, spinal and tubular bone involvement, and subclavian venous obstruction, may or may not be present.
References: 1. Resnick D. Osteomyelitis, septic arthritis, and soft tissue infection: Mechanisms and situations.
In Resnick D. Diagnosis of bone and joint disorders. 2nd ed. Philadelphia: Saunders, 1995: 1228-1229
Keywords: Sternum, Non-infectious inflammation,

No. of Applicants : 36

▶ Correct Answer : 16/36, 44.4%

- Asan Medical Center, Korea Eun Jin Chae
- Annecy Hospital, France Gilles Genin
- Calmette Hospital, Lille, France Philippe Dumont
- Maimonides Medical Center, N.Y., USA Naomi Twersky
- Centre d'imagerie Jacques Callot. Nancy, France Lionel Cannard
- CHU Grenoble, France Methieu Rodiere
- CHU Grenoble, France Delphine Collomb
- CHU Nancy-Brabois, France Denis Regent
- CHU Nancy-Brabois, France Tissier Samuel
- CIM Saint Dizier, France JC Leclerc
- Kangseo Songdo hospital, Korea Ji Young Yun
- Seoul National University Hospital, Korea Sang Young Kim
- Seoul National University Hospital, Korea Euna Park
- Sherbrooke University, Qc, Canada Jean-Sebastien Billiard
- Social Security Hospital, Ankara, Turkey Meric Tuzun
- Tokyo Kouseinenkin Hospital , Japan Noriatsu Ichiba

▶ Semi-Correct Answer : 1/36, 2.8%

- Ohio State University, Ohio, USA Sumit Seth

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 291 Date 2003-05-24

Discussion

No. of Applicants : 36