Graves' disease associated with intersterno-costoclavicular ossification and pustulosis palmoplantaris--a case report and review of the literature

It was shown that intersterno-costoclavicular ossification often appears together with pustulosis palmoplantaris by Sonozaki et al., 1980. We report here a patient of Graves' disease associated with intersterno-costoclavicular ossification and pustulosis palmoplantaris, and discuss the relationship with these conditions.

Musculoskeletal chest wall pain

The musculoskeletal structures of the thoracic wall and the neck are a relatively common source of chest pain. Pain arising from these structures is often mistaken for angina pectoris, pleurisy or other serious disorders. In this article the clinical features, pathogenesis and management of the various musculoskeletal chest wall disorders are discussed. The more common causes are costochondritis, traumatic muscle pain, trauma to the chest wall, "fibrositis" syndrome, referred pain, psychogenic regional pain syndrome, and arthritis involving articulations of the sternum, ribs and thoracic spine. Careful analysis of the history, physical findings and results of investigation is essential for precise diagnosis and effective treatment.

Pustulotic arthroosteitis

We describe the case of a white male with chronic inflammation of one knee, the sternoclavicular area and the dorsal spine, who also had pustulosis palmaris et plantaris. Radiological changes were suggestive of pustulotic arthroosteitis. Our patient had prominent peripheral joint changes not previously emphasized.

Secondary malignant synovitis: report of three cases and review of the literature

Metastatic malignant deposits in joints are rare and only 16 cases have been described. The details of three further cases are presented, a girl with Hodgkin's lymphoma in a sternoclavicular joint, an elderly lady with carcinoma of the ascending colon and knee metastases and a middle-aged man, also with knee deposits, from an adenocarcinoma of lung. The clinical features together with details of synovial fluid cytology of all 19 cases are analysed.

Sternoclavicular joint arthritis: an unusual presentation of metastatic carcinoma

Metastatic carcinoma presenting as sternoclavicular joint arthritis has only recently been reported. We describe a unique case of carcinoma arising from the tongue presenting with bilateral enlargement of the sternoclavicular joints. Diagnosis of metastatic squamous cell disease was made antemortem by Wright's stain and cytology of a joint fluid aspirate; the primary eluded detection until postmortem examination. Primary carcinoma of the tongue and oral cavity should be considered when confronted with metastatic squamous cell disease.

Manubriosternal joint subluxation in rheumatoid arthritis

Manubriosternal joint involvement in rheumatoid arthritis is not rare and may be evidenced by erosion, reactive sclerosis and ankylosis. Frequent reports of such involvements appear in the radiological literature but only 3 cases where this had been associated with clinically evident subluxation of the joint have been reported previously. It is, nonetheless, our observation that clinical deformity of this joint is common and careful review at our clinic has revealed the 10 cases reported here. Chronic or recurrent chest infections have been incriminated in the production of this deformity. However, the evidence seen in our series suggests rather, that this deformity is closely associated with severe cervicodorsal spinal erosion and deformity and that its presence should alert clinicians to potential problems of cervical cord compression.

Posterior dislocation of the clavicle causing fatal tracheoesophageal fistula

A 24-year-old man severely injured in a motor vehicle accident was found to have, on the right side, a pneumothorax, extrapleural hematoma, acromioclavicular dislocation and fracture of the first three ribs and of the transverse processes of C7 and T1. Through a right thoracotomy, transection of the right main stem bronchus and a laceration of the left main stem bronchus were discovered. These were repaired. Twenty days after admission, posterior dislocation of the clavicle at the sternum was noted. A diagnosis of tracheoesophageal fistula was made on the 32nd day but the symptoms had been sternoclavicular and acromioclavicular dislocations. At autopsy the medial end of the clavicle was found to be torn from its articular discand and locked behind the manubrium. The fistula was behind the posterior capsule between the carina and esophagus. The authors conclude that continued pressure from the displaced clavicle may have led to delayed necrosis of the esophagus and that reduction of the dislocated clavicle might have saved the patient's life.

Isolated staphylococcal infection of the sternoclavicular joint

An acute monoarticular infection of the sternoclavicular joint due to coagulase-positive Staphylococcus aureus occurred without predisposing factors in a 48-year-old man. Pyogenic infection must be considered as a cause of pain and swelling of the sternoclavicular joint. Correctly diagnosed and promptly treated, the end results of sternoclavicular joint infection can be excellent.