Garré's chronic diffuse sclerosing osteomyelitis of the sacrum: a rare condition mimicking malignancy

Garrè Sclerosing Osteomyelitis of the Clavicle: Clinical Results after Clavicular Resection

(1) Background: Chronic non-bacterial osteomyelitis (CNO), also known as sclerosing osteomyelitis of Garrè, is a rare inflammatory bone disease with a specific clinical picture, uncertain pathogenesis, and no consensus on an effective treatment. Most frequently affecting other long bones, CNO may rarely involve the clavicle. The aim of this study was to present the results of a series of patients affected by CNO of the clavicle treated with total and partial clavicula resection. In addition, a literature review of different types of treatment of CNO was performed. (2) Methods: We retrospectively reviewed three patients with Sclerosing Osteomyelitis of Garre' of the clavicle treated with partial resection of the clavicle (one) and with total clavicular resection (two). (3) Results: Patients (two female and one male) were an average age of 35.7 years at the time of the operation. At the 4-year follow-up, the mean active ROM was: 143° forward flexion, 133° abduction, 42° external rotation with an internal rotation of two patients at the interscapular level and one patient at the lumbosacral junction. The mean ASES score was 92/100 (range 87-100). In the literature review, after screening the abstracts and full texts for eligibility, 34 studies met the inclusion criteria. Conclusions: Partial or total clavicular resection resulted an effective treatment of CNO of the clavicle. The procedure seems to be particularly indicated after the failure of more conservative treatments.

Sclerosing Osteomyelitis of Garré: A Clinico-Radiological Correlation

Sclerosing osteomyelitis of Garré is a rare and very specific type of chronic osteomyelitis that mainly affects children and young adults. To date, there is no clear etiology for the disease. Clinical findings and laboratory results are usually unremarkable with commonly negative blood and tissue cultures. Cortical thickening and periosteal reaction are common radiological findings. Biopsy often shows chronic non-specific inflammatory changes. It is a well-described entity in the dental literature, but to the best of our knowledge, there are no distinctive diagnostic criteria for long bones. We report a case of sclerosing osteomyelitis of Garré in a young lady involving the right tibia, for which the diagnosis was made based on clinico-radiological correlation.

A rare case: sclerosing osteomyelitis of the frontal bone

The patient presented in this study had a form of chronic sclerosing osteomyelitis (CSO) that is rarely reported in calvarial bones and has never been reported in the frontal bone in the literature. We aimed to contribute to the literature with this case study. In this study, we report a 14-year-old girl who presented with swelling and pain in the frontal bone and underwent treatment due to CSO. The patient had no history of trauma and chronic infection. We conclude that CSO should be considered in the differential diagnosis of the patients presenting with cranial swelling whose diagnosis cannot be established based on the radiological findings.

A 53-year-old man with a sclerosing rib lesion: A case report

RATIONALE

Sclerosing osteomyelitis of Garré is a rare condition that occurs most commonly in tubular bones and the mandible. Its nontypical symptoms, low morbidity, and insidious process make its diagnosis difficult at an early stage. In this article, we reported a case of chronic sclerosing osteomyelitis which occurred in flat bone.

PATIENT CONCERNS

A 53-year-old man was diagnosed with rib sclerosing osteomyelitis of Garré who had an 8-year course of intermittent local pain and swelling, which radiated toward the left side of his chest wall. Chest computed tomography (CT) showed irregular sclerosis of the diaphysis of the 10th rib, with periosteal reaction and narrowing of the medullary cavity, and magnetic resonance imaging (MRI) showed T2 heterogeneous low-signal intensity over the 10th rib.

DIAGNOSES

Based on the features of the clinical signs and radiography and biopsy of the lesion, diagnosis of rib sclerosing osteomyelitis of Garré was made.

INTERVENTIONS

The patient was treated with surgical excision of a 10-cm-long lesion after failed conservative treatment.

OUTCOMES

Postoperatively, the patient achieved good functional recovery at the 10-year follow-up.

LESSONS

Rib sclerosing osteomyelitis of Garré is an unusual condition and represents a noninfective course in the rib with a low morbidity. The surgical management was successful in relieving the patient's symptom.

[Garre's chronic sclerosing osteomyelitis with sacral involvement in a child]

We report the case of a 6 year old patient who started with abdominal pain and left sciatica, which did not improve after applying symptomatic treatment. A complete analytical and imaging study was performed, which showed a lesion in left S1 corresponding to Garrè's chronic diffuse sclerosing osteomyelitis. The diagnosis was confirmed by biopsy of the lesion. Treatment was established with corticosteroids and anti-inflammatory drugs, obtaining a clinical improvement, although in the follow-up imaging tests 2 years after the onset of the symptoms, the lesion persists but with a significant reduction in its size.

Management of metastatic sacral tumours

PURPOSE

Metastatic involvement of the sacrum is rare and there is a paucity of studies which deal with the management of these tumours since most papers refer to primary sacral tumours. This study aims to review the available literature in the management of sacral metastatic tumours as reflected in the current literature.

METHODS

A systematic review of the English language literature was undertaken for relevant articles published over the last 11 years (1999-2010). The PubMed electronic database and reference lists of key articles were searched to identify relevant studies using the terms "sacral metastases" and "metastatic sacral tumours". Studies involving primary sacral tumours only were excluded. For the assessment of the level of evidence quality, the CEBM (Oxford Centre of Evidence Based Medicine) grading system was utilised.

RESULTS

The initial search revealed 479 articles. After screening, 16 articles identified meeting our inclusion criteria [1 prospective cohort study on radiosurgery (level II); 2 case series (level III); 4 retrospective case series (level IV) and 9 case reports (level IV)].

CONCLUSION

The mainstay of management for sacral metastatic tumours is palliation. Preoperative angioembolisation is shown to be of value in cases of highly vascularised tumours. Radiotherapy is used as the primary treatment in cases of inoperable tumours without spinal instability where pain relief and neurological improvement are attainable. Minimal invasive procedures such as sacroplasties were shown to offer immediate pain relief and improvement with ambulation, whereas more aggressive surgery, involving decompression and sacral reconstruction, is utilised mainly for the treatment of local advanced tumours which compromise the stability of the spine or threaten neurological status. Adjuvant cryosurgery and radiosurgery have demonstrated promising results (if no neurological compromise or instability) with local disease control.

Chronic pelvic pain reveals sacral osteomyelitis three years after abdominal hysterectomy

BACKGROUND

Deep pelvic abscess is a well-known infective complication in gynecologic practice. However, sacral osteomyelitis has been reported rarely. We describe sacral infection presenting three years after abdominal hysterectomy and point out the difficulty in management.

METHODS

Case report and review of the pertinent literature.

RESULTS

A 46-year-old woman who had undergone abdominal hysterectomy three years before presented with an 8-month history of abdominopelvic pain recently intensifying in the sitting position without fever. Gynecologic, urinary, and rectal examination did not yield positive findings. An abdominopelvic computed tomography (CT) scan was normal except for sacral osteolysis. A neoplasm was suspected, but magnetic resonance imaging revealed an S2-S4 cystic collection with presacral extension. Neurologic examination did not show any focal deficits. A posterior CT-guided biopsy-aspiration yielded purulent fluid. Pathologic examination revealed inflammatory granulations without any malignant tumor. Abscess cultures grew three microorganisms. The patient's symptoms resolved completely after 3 months of antibiotic therapy.

CONCLUSIONS

Sacral osteomyelitis has not been reported previously after abdominal hysterectomy. Early diagnosis was made difficult by the absence of neurologic findings. Such postoperative infection should be considered after pelvic surgery. Minimally invasive needle aspiration may confirm the diagnosis and reduce the necessary extent of surgical intervention.

Sacral tumors and management

The evaluation and complex treatments of sacral tumors require a multidisciplinary approach. Because of the complex anatomy conditions and biomechanics of the lumbo-pelvic junction, surgical treatment of sacral neoplasms is one of the most challenging fields in spine. Here, diagnostic process and surgical and nonsurgical treatment options for sacral tumors are summarized based on the literature and on the authors' own experiences.