1
|
Similarities and Differences between Clavicular Bacterial Osteomyelitis and Nonbacterial Osteitis: Comparisons of 327 Reported Cases. J Immunol Res 2021; 2021:4634505. [PMID: 33575360 PMCID: PMC7857900 DOI: 10.1155/2021/4634505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 01/03/2021] [Accepted: 01/09/2021] [Indexed: 12/19/2022] Open
Abstract
Background Currently, both clavicular bacterial osteomyelitis (BO) and nonbacterial osteitis (NBO) remain not well understood owing to their much lower incidences. This study is aimed at summarizing similarities and differences between clavicular BO and NBO based on comparisons of literature-reported cases. Methods We searched the PubMed and Embase databases to identify English published literature between January 1st, 1980, and December 31st, 2018. Inclusion criteria were studies evaluating clinical features, diagnosis, and treatment of clavicular BO and NBO, with eligible data for synthesis analysis. Results Altogether, 129 studies with 327 patients were included. Compared with BO, clavicular NBO favored females (P < 0.001) and age below 20 years (P < 0.001) and mostly presented in a chronic phase (disease term exceeding 2 months) (P < 0.001). Although local pain and swelling were the top two symptoms for both disorders, fever, erythema, and a sinus tract were more frequently found in BO patients (P < 0.01). Although they both favored the medial side, lesions in the clavicular lateral side mostly occurred in BO patients (P = 0.002). However, no significant differences were identified regarding the serological levels of white blood cell count (P = 0.06), erythrocyte sedimentation rate (P = 0.27), or C-reactive protein (P = 0.33) between BO and NBO patients before therapy. Overall, the BO patients achieved a statistically higher cure rate than that of the NBO patients (P = 0.018). Conclusions Females, age below 20 years, and a long duration of clavicular pain and swelling may imply NBO. While the occurrence of a sinus tract and lesions in the lateral side may be clues of BO, inflammatory biomarkers revealed limited values for differential diagnosis. BO patients could achieve a better efficacy than the NBO patients based on current evidence.
Collapse
|
2
|
Chronic nonbacterial osteomyelitis - clinical and magnetic resonance imaging features. Pediatr Radiol 2021; 51:282-288. [PMID: 33033917 PMCID: PMC7846524 DOI: 10.1007/s00247-020-04827-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/25/2020] [Accepted: 08/23/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chronic nonbacterial osteomyelitis (CNO) is a rare autoinflammatory bone disorder. Little information exists on the use of imaging techniques in CNO. MATERIALS AND METHODS We retrospectively reviewed clinical and MRI findings in children diagnosed with CNO between 2012 and 2018. Criteria for CNO included unifocal or multifocal inflammatory bone lesions, symptom duration >6 weeks and exclusion of infections and malignancy. All children had an MRI (1.5 tesla) performed at the time of diagnosis; 68 of these examinations were whole-body MRIs including coronal short tau inversion recovery sequences, with additional sequences in equivocal cases. RESULTS We included 75 children (26 boys, or 34.7%), with mean age 10.5 years (range 0-17 years) at diagnosis. Median time from disease onset to diagnosis was 4 months (range 1.5-72.0 months). Fifty-nine of the 75 (78.7%) children presented with pain, with or without swelling or fever, and 17 (22.7%) presented with back pain alone. Inflammatory markers were raised in 46/75 (61.3%) children. Fifty-four of 75 (72%) had a bone biopsy. Whole-body MRI revealed a median number of 6 involved sites (range 1-27). Five children (6.7%) had unifocal disease. The most commonly affected bones were femur in 46 (61.3%) children, tibia in 48 (64.0%), pelvis in 29 (38.7%) and spine in 20 (26.7%). Except for involvement of the fibula and spine, no statistically significant differences were seen according to gender. CONCLUSION Nearly one-fourth of the children presented with isolated back pain, particularly girls. The most common sites of disease were the femur, tibia and pelvic bones. Increased inflammatory markers seem to predict the number of MRI sites involved.
Collapse
|
3
|
Hu WR, Yao ZL, Yu B, Jiang N. Clinical characteristics and treatment of clavicular osteomyelitis: a systematic review with pooled analysis of 294 reported cases. J Shoulder Elbow Surg 2019; 28:1411-1421. [PMID: 30826202 DOI: 10.1016/j.jse.2018.11.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is usually difficult to diagnose clavicular osteomyelitis (OM), and treatment is delayed because of its rarity. This study aimed to summarize clinical characteristics and treatment of this disease. METHODS We searched the PubMed and Embase databases to identify English studies that reported on clavicular OM from January 1980 through December 2016. Effective data were pooled for analysis. RESULTS In total, 111 studies comprising 294 cases (bacterial OM, 146; nonbacterial OM, 148) were included, with a sex ratio of 1.89:1 indicating female predilection. Overall, the median age at diagnosis was 16 years. The acute to chronic phase ratio was 0.30, with a median symptom duration of 4 months. The most frequently reported symptom was pain (192 cases), followed by swelling (151 cases) and fever (52 cases). Altogether, 86.94% cases of single-site involvement were reported, with the medial side being the most common site (69.95%). The erythrocyte sedimentation rate achieved the highest positive rate (74.44%) before treatment. The total positive rate of culture for bacterial OM was 81.82%, with Staphylococcus aureus being the most frequently detected pathogen (44.70%). The average cure rate was 83.52%, with no significant difference between surgical (89.70%) and nonsurgical (79.63%) cases (P = .079). CONCLUSIONS Clavicular OM, predominant in female patients and young people, usually occurred at a chronic stage. Pain was the most frequent symptom, with the medial side being the most involved site. The erythrocyte sedimentation rate may be a helpful indicator for diagnosis. Regardless of surgery or nonsurgery, most patients achieved a favorable prognosis.
Collapse
Affiliation(s)
- Wei-Ran Hu
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zi-Long Yao
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Yu
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Nan Jiang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| |
Collapse
|
4
|
Girschick H, Finetti M, Orlando F, Schalm S, Insalaco A, Ganser G, Nielsen S, Herlin T, Koné-Paut I, Martino S, Cattalini M, Anton J, Mohammed Al-Mayouf S, Hofer M, Quartier P, Boros C, Kuemmerle-Deschner J, Pires Marafon D, Alessio M, Schwarz T, Ruperto N, Martini A, Jansson A, Gattorno M. The multifaceted presentation of chronic recurrent multifocal osteomyelitis: a series of 486 cases from the Eurofever international registry. Rheumatology (Oxford) 2018; 57:1203-1211. [PMID: 29596638 DOI: 10.1093/rheumatology/key058] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 02/08/2018] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Chronic non-bacterial osteomyelitis (CNO) or chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory disorder characterized by sterile bone osteolytic lesions. The aim of this study was to evaluate the demographic data and clinical, instrumental and therapeutic features at baseline in a large series of CNO/CRMO patients enrolled in the Eurofever registry. METHODS A web-based registry collected retrospective data on patients affected by CRMO/CNO. Both paediatric and adult centres were involved. RESULTS Complete baseline information on 486 patients was available (176 male, 310 female). The mean age of onset was 9.9 years. Adult onset (>18 years of age) was observed in 31 (6.3%) patients. The mean time from disease onset to final diagnosis was 1 year (range 0-15). MRI was performed at baseline in 426 patients (88%), revealing a mean number of 4.1 lesions. More frequent manifestations not directly related to bone involvement were myalgia (12%), mucocutaneous manifestations (5% acne, 5% palmoplantar pustulosis, 4% psoriasis, 3% papulopustular lesions, 2% urticarial rash) and gastrointestinal symptoms (8%). A total of 361 patients have been treated with NSAIDs, 112 with glucocorticoids, 61 with bisphosphonates, 58 with MTX, 47 with SSZ, 26 with anti-TNF and 4 with anakinra, with a variable response. CONCLUSION This is the largest reported case series of CNO patients, showing that the range of associated clinical manifestations is rather heterogeneous. The study confirms that the disease usually presents with an early teenage onset, but it may also occur in adults, even in the absence of mucocutaneous manifestations.
Collapse
Affiliation(s)
- Hermann Girschick
- Paediatric and Adolescent Medicine, Perinatal Centre, Clinic for Paediatric and Adolescent Medicine, Vivantes Klinikum Berlin, Germany
- Section of Paediatric Rheumatology, Children's Hospital, Osteology, Immunology and Infectious Diseases, University of Wuerzburg, Germany
| | - Martina Finetti
- Istituto Giannina Gaslini, Pediatria II, Reumatologia, Genoa
| | - Francesca Orlando
- Istituto Giannina Gaslini, Pediatria II, Reumatologia, Genoa
- Dipartimento di Pediatria, Università di Napoli Federico II, Naples
| | - Susanne Schalm
- Klinikum der Universität, von Haunersches Kinderspital, Munich, Germany
| | | | - Gerd Ganser
- Clinic of Paediatric Rheumatology, St. Josef-Stift Hospital, Sendenhorst, Germany
| | - Susan Nielsen
- Paediatric Rheumatology, Rigshospitalet, Copenhagen, Denmark
| | - Troels Herlin
- Skejby Sygehus, Aarhus University Hospital, Aarhus, Denmark
| | - Isabelle Koné-Paut
- Service de rhumatologie pédiatrique, Le Kremlin-Bicêtre University Hospital, Paris-Sud University, Paris, France
| | - Silvana Martino
- Dipartimento di Scienze Pediatriche e dell'Adolescenza, University of Torino, Torino, Italy
| | - Marco Cattalini
- Unita di Immunologia e Reumatologia Pediatrica, Clinica Pediatrica dell'Universita di Brescia, Spedali Civili, Brescia, Italy
| | - Jordi Anton
- Paediatric Rheumatology, Hospital Sant Joan de Déu. Universitat de Barcelona, Spain
| | | | - Michael Hofer
- Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Pierre Quartier
- IMAGINE Institute, Paris-Descartes University, Necker Children's Hospital, Paris, France
| | - Christina Boros
- Paediatrics and Reproductive Health, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | | | | | - Maria Alessio
- Dipartimento di Pediatria, Università di Napoli Federico II, Naples
| | - Tobias Schwarz
- Section of Paediatric Rheumatology, Children's Hospital, Osteology, Immunology and Infectious Diseases, University of Wuerzburg, Germany
- Clinic of Paediatric Rheumatology, St. Josef-Stift Hospital, Sendenhorst, Germany
| | | | - Alberto Martini
- Direzione Scientifica, Istituto Giannina Gaslini, Genoa, Italy
| | - Annette Jansson
- Klinikum der Universität, von Haunersches Kinderspital, Munich, Germany
| | - Marco Gattorno
- Istituto Giannina Gaslini, Pediatria II, Reumatologia, Genoa
| |
Collapse
|
5
|
|
6
|
Frangos CC, Frangos CC. George Higoumenakis (1895-1983): Greek dermatologist. JOURNAL OF MEDICAL BIOGRAPHY 2009; 17:64-72. [PMID: 19401507 DOI: 10.1258/jmb.2009.009005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This paper describes the Higoumenakis sign, enlargement of the sternal end of the clavicle in patients with late congenital syphilis and the dermatologist after whom it is named. Several professors and doctors from the Medical School of the University of Athens opposed his actions especially at the University in Greece. His persistence led him to productive scientific activity in syphilis, leishmaniasis and psoriasis. He became a member of the Greek Parliament from 1964 to 1967 and eventually Minister of Hygiene - even though this may have been an imprudent political choice, due to the unstable socio-political status of that period. He died on 27 December 1983 at the age of 88.
Collapse
|
7
|
Girschick HJ, Raab P, Surbaum S, Trusen A, Kirschner S, Schneider P, Papadopoulos T, Müller-Hermelink HK, Lipsky PE. Chronic non-bacterial osteomyelitis in children. Ann Rheum Dis 2005; 64:279-85. [PMID: 15647436 PMCID: PMC1755336 DOI: 10.1136/ard.2004.023838] [Citation(s) in RCA: 180] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Chronic recurrent multifocal osteomyelitis (CRMO) in children is a chronic non-suppurative inflammation involving multiple sites. Some children affected by chronic non-bacterial osteomyelitis (CNO) do not have multiple lesions or a recurrent course. OBJECTIVE To characterise the long term outcome of children with the full spectrum of CNO. METHODS 30 children diagnosed with CNO were followed up for a mean of 5.6 years and their disease assessed using a clinical score, multiple imaging, and a diagnostic biopsy, including extensive microbial analysis. RESULTS 9 patients had unifocal non-relapsing disease, 3 unifocal lesions with relapses, 9 multifocal lesions without relapses, and 9 multifocal lesions with relapses (CRMO). Granulocytes were present significantly more often in CRMO than in unifocal and non-recurrent lesions. Pustulosis was more common in multifocal cases regardless of recurrence. Mean duration of treatment in 15 children with a single occurrence was 9.2 months. Naproxen treatment was generally effective. Naproxen treatment in 12 patients with relapses lasted 25 months. However, 7 of these were not effectively treated with naproxen alone. Five were treated with oral glucocorticoids for 27 days in addition to naproxen, which induced remission in four, lasting for at least 1.5 years. Longitudinal growth of affected bones was not altered, except for the development of hyperostosis. CONCLUSION CNO is a spectrum of inflammatory conditions, with CRMO being the most severe. Most children with CNO have a favourable outcome of the disease. Oral glucocorticoids may be necessary in severe recurrent cases.
Collapse
Affiliation(s)
- H J Girschick
- Section of Paediatric Rheumatology, Children's Hospital, University of Würzburg, Josef-Schneider-Strasse 2, 97080 Würzburg, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Affiliation(s)
- Hendrik Everaert
- Department of Nuclear Medicine, Academic Hospital of the Free University-Brussels (AZ VUB), Laarbeeklaan 101, 1090 Brussels, Belgium.
| | | | | | | | | |
Collapse
|
9
|
Girschick HJ, Huppertz HI, Harmsen D, Krauspe R, Müller-Hermelink HK, Papadopoulos T. Chronic recurrent multifocal osteomyelitis in children: diagnostic value of histopathology and microbial testing. Hum Pathol 1999; 30:59-65. [PMID: 9923928 DOI: 10.1016/s0046-8177(99)90301-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chronic recurrent, unifocal or multifocal osteomyelitis (CRMO), an inflammatory disorder of unknown origin, involves different osseous sites and may be associated with palmoplantar pustulosis. Bacterial cultures of affected tissue were reported negative in nearly all cases. Radiological and magnetic resonance imaging features of CRMO have been described, but differential diagnosis remains difficult, including rheumatic diseases, bacterial osteomyelitis, and malignancy. Although definite diagnosis relies on histopathologic confirmation by biopsy, histopathologic criteria have not been defined. Because CRMO may be treated with nonsteroidal antiinflammatory drugs, but not antibiotics, distinguishing CRMO from bacterial osteomyelitis is of major importance. Histopathologic analysis of 12 patients with CRMO indicated a wide variation of reparative changes of bone, but chronic inflammation could not be found at all sites in the same biopsy. The inflammatory infiltrate was mostly scattered, consisting mainly of lymphocytes, plasma cells, histiocytes, and also few neutrophil granulocytes. Immunohistochemistry showed a predominance of CD3(+), CD45RO(+) T-cells, which were mainly CD8(+). In addition, CD20(+) B cells and CD68(+) macrophages were abundant in each biopsy specimen. Mild lymphocytic and granulocytic infiltrates were also detected in three synovial biopsy specimens obtained from adjacent joints. All bacterial and fungal cultures from native biopsy tissues were negative. Amplification of partial-length 16S ribosomal DNA by polymerase chain reaction (PCR) using broad-range eubacterial primers was below the detection limit in all patients. Because histopathologic features alone may not provide conclusive evidence, CRMO should be included in the differential diagnosis of chronic inflammatory bone lesions in children, and the definite diagnosis should be made by the clinical picture, x-ray studies, bone scan, bacterial culture, and histopathologic analysis in a multidisciplinary approach.
Collapse
Affiliation(s)
- H J Girschick
- Universitäts-Kinderklinik und Poliklinik, the Institut für Hygiene und Mikrobiologie, Universität Würzburg, Germany
| | | | | | | | | | | |
Collapse
|
10
|
Rand T, Schweitzer M, Rafii M, Nguyen K, Garcia M, Resnick D. Condensing osteitis of the clavicle: MRI. J Comput Assist Tomogr 1998; 22:621-4. [PMID: 9676456 DOI: 10.1097/00004728-199807000-00021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Condensing osteitis of the clavicle is a rare benign disorder, seen exclusively in women and characterized by expansion and sclerosis of the medial end of the clavicle. The aim of this study was to evaluate the MR findings of this disorder. METHOD MR images, obtained in four patients with evidence of condensing osteitis of the clavicle based on plain radiographs and clinical symptoms, included pre- and postcontrast T1 SE sequences, T2 SE images, GE images. RESULTS MR images revealed consistent hypointense areas on T1-weighted SE images, corresponding to regions of clavicular sclerosis (n = 4). T2-weighted SE images showed signal characteristics ranging from low intermediate signal intensity in regions of sclerosis (n = 4). T2-weighted GE images revealed moderate to high signal intensity presumably related to bone marrow edema (n = 2). Contrast-enhanced T1-weighted SE images were characterized by mild to extensive intraosseous and periosseous enhancement of signal intensity (n = 2). CONCLUSION MRI in cases of condensing osteitis of the clavicle reveals variable findings perhaps indicative of different stages of activity in this disease.
Collapse
Affiliation(s)
- T Rand
- Department of Radiology, Veterans Affairs Medical Center, San Diego, CA 92161, USA
| | | | | | | | | | | |
Collapse
|
11
|
Tan BS, Nayanar V, Mansberg R, Murray IP, Rossleigh MA. Two cases of chronic recurrent multifocal osteomyelitis: radiological and scintigraphic findings. AUSTRALASIAN RADIOLOGY 1996; 40:437-41. [PMID: 8996908 DOI: 10.1111/j.1440-1673.1996.tb00443.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is an extremely rare condition, of uncertain aetiology. Since first described, in 1972, under 100 cases have been reported. It is being reported with increasing frequency, and many cases of this disease go unreported. It most commonly affects patients in childhood or adolescence. No infective agent has been identified, and antibiotics do not affect the course of the disease. We present the cases of two female children with this disorder, describe the radiological and scintigraphic findings and review the literature. Case 1 is the first reported case to our knowledge of CRMO presenting with cranial nerve palsies.
Collapse
Affiliation(s)
- B S Tan
- Department of Nuclear Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | | | | | | | | |
Collapse
|
12
|
Apter S, Hertz M, Salai M, Nerubai J, Bubis JJ. Post-traumatic reactive and resorptive lesions of the medial end of the clavicle. Clin Imaging 1992; 16:40-2. [PMID: 1540862 DOI: 10.1016/0899-7071(92)90089-r] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Three soldiers presented with a painful swelling of the sternoclavicular area. Computed tomography (CT) studies showed sclerosis as well as lysis of the medial end of the clavicle with adjacent soft-tissue swelling. Bone biopsy revealed new bone formation and inflammatory reaction; cultures were negative, no tumor cells were found. The patients recovered after antibiotic treatment. Although the CT findings cannot completely rule out a malignant lesion, these changes in the medial end of the clavicle in young people may suggest trauma as the etiology.
Collapse
Affiliation(s)
- S Apter
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | | |
Collapse
|
13
|
Machiels F, Seynaeve P, Lagey C, Mortelmans LL. Chronic recurrent multifocal osteomyelitis with MR correlation: a case report. Pediatr Radiol 1992; 22:535-6. [PMID: 1491916 DOI: 10.1007/bf02013005] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is a rare disorder of unknown etiology. The main characteristics on plain X-rays are a lytic destruction in the metaphyseal region of the long bones followed by progressive sclerosis. The symmetrical pattern and the frequent involvement of the sternoclavicular joints and vertebrae are typical. An association with palmoplantar pustulosis has also been described. Laboratory findings are nonspecific. Although MRI is not necessary to make the diagnosis of chronic osteomyelitis, it is useful in assessing the extent and the evolution of the lesions. CRMO of the tibial and fibular bones is described in a 14-year-old girl, who suffered from pain and soft tissue swelling in both ankles. Initial plain X-rays and laboratory findings were normal. After relapsing clinically, progressive sclerosis of both fibular bones occurred. Lytic lesions in the left tibia and both fibular bones were visible. Scintigraphic examination showed pathologic tracer accumulation in both legs. The diagnosis of CRMO was suggested based on CT and MRI findings. CRMO was confirmed after curettage and bone biopsy. Histopathological findings were consistent with active chronic osteomyelitis.
Collapse
Affiliation(s)
- F Machiels
- Department of Radiology, Middleheim Hospital Antwerp, Belgium
| | | | | | | |
Collapse
|
14
|
Eftekhari F, Jaffe N, Schwegel D, Ayala A. Inflammatory metachronous hyperostosis of the clavicle and femur in children. Report of two cases, one with long-term follow-up. Skeletal Radiol 1989; 18:9-14. [PMID: 2711216 DOI: 10.1007/bf00366762] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Two preteenage girls developed painful swelling of the left clavicle. This was followed by painful swelling of the femur, 7 months later in one girl and 8 years later in the other. Radiographic studies showed a predominantly sclerotic process in one patient and destruction associated with cortical thickening in the other. The patients received analgesic medications only, followed by gradual healing with cortical and medullary sclerosis. Long-term follow-up suggests that the condition is self-limited and that, with or without treatment, the bones eventually return to normal. Although the etiology of the lesions remains unknown, the radiographic features suggest an inflammatory reaction.
Collapse
Affiliation(s)
- F Eftekhari
- Department of Radiology, University of Texas M.D. Anderson Cancer Center, Houston
| | | | | | | |
Collapse
|
15
|
Abstract
Fifty eight patients seen at Memorial Sloan-Kettering Cancer Center over a 50-year period were reviewed for lesions of the clavicle. A variety of malignant neoplasms, benign neoplasms, and tumor-like lesions were seen. There were 30 malignant neoplasms, the commonest of which were plasmacytomas, osteosarcomas, and Ewing sarcomas. There were five postradiation sarcomas. An unusual granulocytic sarcoma with dense sclerosis was described. Among the benign lesions were two osteochondromas, two hemangiomas, and a giant cell tumor secondary to Paget disease. The tumor-like lesions included six aneurysmal bone cysts and five eosinophilic granulomas. There were two patients with chronic sclerosing osteomyelitis and one each with sternocostoclavicular hyperostosis (Sonozaki syndrome) and condensing osteitis. An unusually large lesion of pseudogout and a large brown tumor were also included in the series.
Collapse
Affiliation(s)
- J Smith
- Department of Medical Imaging, Memorial Sloan-Kettering Cancer Center, NY 10021
| | | | | |
Collapse
|
16
|
Jurik AG, Helmig O, Graudal H. Skeletal disease, arthro-osteitis, in adult patients with pustulosis palmoplantaris. Scand J Rheumatol Suppl 1988; 70:3-15. [PMID: 2453079 DOI: 10.3109/03009748809093406] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A follow-up study of 13 patients with pustulosis palmoplantaris (PPP) and skeletal disease is reported. A prolonged and fluctuating course occurred in all patients. Nine patients had anterior chest wall involvement with erosions or ankylosis of the sternoclavicular, first sternocostal and/or manubriosternal joint together with sclerosis and often hyperostosis of adjacent bones, ossification/calcification of the first costal cartilage, and in 7 patients of the costoclavicular ligament. Spinal involvement in the form of spondylodiscitis, sclerosis of vertebral bodies, syndesmophytes, paravertebral ossifications and/or spondyloarthritis occurred in 11 patients, three of whom also had involvement of the sacroiliac joints. One patient had sclerosis of a pubic and ischial bone. Peripheral arthritis or tenosynovitis occurred in 5 patients, two of whom had signs of enthesopathy, and one also erosions. The presence of a distinct PPP syndrome is suggested.
Collapse
Affiliation(s)
- A G Jurik
- Department of Diagnostic Radiology, Municipal Hospital, Denmark
| | | | | |
Collapse
|
17
|
Jurik AG, Møller BN. Chronic sclerosing osteomyelitis of the clavicle. A manifestation of chronic recurrent multifocal osteomyelitis. ARCHIVES OF ORTHOPAEDIC AND TRAUMATIC SURGERY. ARCHIV FUR ORTHOPADISCHE UND UNFALL-CHIRURGIE 1987; 106:144-51. [PMID: 3606353 DOI: 10.1007/bf00452200] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The cases of five children/adolescents and two young adults with unilateral chronic osteomyelitis of the clavicle are reported. The clinical course was prolonged and characterized by intermittent periods of exacerbation followed by improvement. Extensive investigations revealed no causative organisms and the disease seemed resistant to antibiotic therapy. The only laboratory abnormality was elevated ESR, present in five cases. Osteomyelitis of other bones was detected in four cases and pustulosis palmoplantaris in two, suggesting that the disease is a manifestation of chronic recurrent multifocal osteomyelitis.
Collapse
|
18
|
Jurik AG, Møller BN, Jensen MK, Jensen JT, Graudal H. Sclerosis and hyperostosis of the manubrium sterni. Rheumatol Int 1986; 6:171-8. [PMID: 3787090 DOI: 10.1007/bf00541284] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Seven females and one male with almost identical sclerotic and hyperostotic changes of the manubrium sterni are reported. The clinical course was prolonged and characterized by intermittent periods of exacerbation followed by improvement. Malignancies, bacterial inflammatory processes, and Paget disease, which were first suspected, could be excluded. Pustulosis-palmoplantaris was present in four patients and one had psoriasis vulgaris. None of the patients had sacroiliitis or peripheral joint changes, but the three youngest patients had sclerotic changes of other bones, including the lumbar spine, the pubic bone, and the clavicle. This may indicate that this is an adult disease analogous to "chronic recurrent multifocal osteomyelitis", a disease mainly present in children and adolescents.
Collapse
|