Primary sternal osteomyelitis: a case series and review of the literature

Spectrum of anatomical variants, normal findings and pathology in and around the paediatric sternum

Abnormalities of the sternum and adjacent structures are an uncommon presentation in the paediatric population and can have a variety of benign and malignant causes, including normal and developmental variants of the chest wall. Although there is overlap with adults, many sternal abnormalities are unique to the paediatric population. Following clinical examination, radiography is usually the first type of imaging used; however, it is limited and often ultrasound and cross-sectional imaging are needed for further assessment. An understanding of the normal anatomy is important; however, this can be challenging due to the varied appearances of age-related changes of the sternum. The purpose of this article is to familiarize the general paediatric radiologist with the expected anatomy and imaging findings of the developing sternum, anatomical variants and pathology of the sternum and adjacent structures encountered in this group of patients.

Osteomyelitis of flat bones: A report of 20 cases and review of the literature

OBJECTIVE

Osteomyelitis is frequently localized on the fertile metaphysis of long bones. However, there are other locations such as short or flat bones. The aim of our study was to determine the diagnostic, therapeutic and evolutionary aspects of osteomyelitis of flat bones in our environment.

METHODS

It's was a retrospective study conducted from January 2013 to December 2017; Children from 0 to 16 years admitted for osteomyelitis of a flat bone where included.

RESULTS

We followed 19 patients who presented 20 locations of osteomyelitis on a flat bone. They accounted for 9.1% of all osteomyelitis observed during the study period. The average age was 6.7 years (9 months-14 years). The clinical picture most often associated with fever and local inflammatory swelling related to an abscess. The predominant locations were the sternum with 8 cases and the scapula with 4 cases. Eleven patients were homozygous sickle cell patients. The diagnosis was strengthened with standard radiography in the majority of cases. A micro-organism was isolated in 8 cases (40%) and Staphylococcus aureus was the predominant germ in 7 cases. Nearly all patients were treated with surgical drainage of the abscess, bone curettage and antibiotics. A typical radiographical evolution has been observed with bone reconstruction in 15 cases with a mean follow-up of 3.3 years.

CONCLUSION

Flat bones are relatively rare locations of osteomyelitis. Standard radiography remains the first-line examination. Their treatment obeys the same rules as that of osteomyelitis of long bones. There is a successful outcome when the care is early and adequate.

Primary Sternal Osteomyelitis With Extensive Mediastinal Abscess in a Neonate

Sternal osteomyelitis is extremely rare in neonates. We present the first report of a neonate with primary sternal osteomyelitis and an extensive mediastinal collection. Magnetic resonance imaging was used to delineate the extent of bony and soft tissue involvement. Serial ultrasound imaging proved useful for monitoring the response to treatment. The patient was successfully treated with antibiotics, surgical débridement, vacuum-assisted dressings, and delayed primary closure.

Primary osteomyelitis of the sternum in the pediatric age group: report of a new case and comprehensive analysis of seventy-four cases

Pediatric primary osteomyelitis of the sternum may have a non-specific onset and be diagnosed late. We analyzed all accessible published cases (n = 73) and 1 new case in order to describe presenting signs and symptoms, laboratory findings, diagnostic imaging features, causative pathogens, treatments, complications and outcomes. This analysis represents the first comprehensive description of the natural history of this rare infection.

Primary Sternal Osteomyelitis Caused by Actinomyces israelii

Primary sternal osteomyelitis is a rare disease. Common infectious organisms causing primary sternal osteomyelitis include Staphylococcus aureus and Pseudomonas aeruginosa. Actinomyces species are common saprophytes of the oral cavity, but there have been few reports in the literature of primary sternal osteomyelitis caused by Actinomyces species. We describe a case of primary sternal osteomyelitis caused by Actinomyces israelii without pulmonary involvement.

Chondrosternal arthritis in infant: an unusual entity

Primary arthritis of chondrosternal joint is very rare and occurs in infants less than 18 months of age. Presentation is most often subacute but may be acute. Child presents with a parasternal mass with history of fever and/or local signs of infection. Clinical symptoms vary from a painless noninflammatory to a painful mass with local tenderness and swelling, while fever may be absent. Laboratory data show low or marginally raised levels of white blood cells and C-reactive protein, reflecting, respectively, the subacute or acute character of the infection. It is a self-limiting affection due to the adequate immune response of the patient. Evolution is generally good without antibiotherapy with a progressive spontaneous healing. A wait-and-see approach with close follow-up in the first weeks is the best therapeutic option.

Sternal tuberculosis in an immunocompetent adult

Skeletal tuberculosis accounts for 1-3% of patients with mycobacterial infection. Any bone can be a site for tuberculosis, but sternum involvement is quite rare. We report the case of a 37-year-old woman admitted because of chest pain and increased swelling over the anterior chest. She was immunocompetent and had no systemic features. She was diagnosed with tuberculosis of the sternum without active pulmonary disease. Conservative management with oral multidrug antituberculous therapy completely cured the patient.

Primary sternal osteomyelitis: a report of two cases with literature review

Primary sternal osteomyelitis is a rare disease in children caused mainly by Staphylococcus aureus. We describe 2 cases resulting from Streptococcus pneumonia and Candida albicans. On the basis of these cases and other documented case reports, we discuss the pathogens, clinical course, and pathophysiology and suggest a management protocol based on early debridement to initiate appropriate antibiotic therapy and shorten hospitalization.

Continuous Infusion of Nafcillin for Sternal Osteomyelitis in an Infant After Cardiac Surgery

We report the use of the continuous infusion of nafcillin for the treatment of an infant who had methicillinsusceptible Staphylococcus aureus sternal osteomyelitis not responsive to traditional nafcillin dosing. The patient was successfully treated with surgical debridement and the continuous infusion of nafcillin. To our knowledge, this is the first report describing the successful use of the continuous infusion of nafcillin to treat an infant who had sternal osteomyelitis after cardiac surgery.

Imaging appearances of the sternum and sternoclavicular joints

The sternum and sternoclavicular joints--critical structures of the anterior chest wall--may be affected by various anatomic anomalies and pathologic processes, some of which require treatment. Pectus excavatum and pectus carinatum are common congenital anomalies that are usually benign but may warrant surgical treatment if they cause compression of vital internal structures. By contrast, developmental variants such as the sternal foramen are asymptomatic and do not require further evaluation or treatment. Arthritides of the sternoclavicular joint (osteoarthritis, septic arthritis, and seronegative arthropathies) are common and must be differentiated before an appropriate management method can be selected. The recognition of complications of sternotomy (eg, sternal dehiscence, secondary osteomyelitis) is critical to avoid life-threatening sequelae such as acute mediastinitis. Likewise, the detection of sternal fractures and sternoclavicular dislocations is important, especially where they impinge on vital structures. In addition, sternal malignancies (most commonly, metastases and chondrosarcoma) must be distinguished from benign neoplasms. To achieve accurate and timely diagnoses that facilitate appropriate treatment, radiologists must be familiar with the appearances of these normal anatomic variants and diseases of the sternum.

Sternal osteomyelitis after minor trauma

Sternal osteomyelitis secondary to minor trauma occurs rarely. Only a handful of cases have been reported. A 24-year-old male patient who had history of intravenous drug abuse and recent minor sternal trauma presented with signs and symptoms of sternal infection. Imaging studies suggested osteomyelitis and the patient underwent sternal resection, with a successful outcome. Sternal osteomyelitis should be suspected in immunocompromised patients, including intravenous drug abusers presenting with sternal inflammatory symptoms. Increased awareness, rapid diagnosis, and appropriate empiric antibiotic and radical surgical treatments can successfully manage life-threatening osteomyelitis of the sternum.

Primary sternal osteomyelitis in a healthy child due to community-acquired methicillin-resistant Staphylococcus aureus and literature review

Primary sternal osteomyelitis is a rare condition. Most of the recent cases have been reported in intravenous drug abusers. A 4-y-old male case of primary sternal osteomyelitis due to community-acquired methicillin-resistant Staphylococcus aureus with no apparent risk factors is reported. The diagnosis should be suspected in a young patient presenting with acute inflammatory swelling over the sternum. While bacteriological culture results are pending, antibiotic therapy with Staphylococcus aureus coverage should be initiated empirically and the possibility of community-acquired methicillin-resistant S. aureus must be borne in mind. In this report we also review the literature of paediatric primary sternal osteomyelitis.