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Choi MH, Yoon IY, Kim WJ. Ultrasound-guided intra-articular corticosteroid injection in a patient with manubriosternal joint involvement of ankylosing spondylitis: A case report. World J Clin Cases 2023; 11:2043-2050. [PMID: 36998969 PMCID: PMC10044947 DOI: 10.12998/wjcc.v11.i9.2043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/28/2022] [Accepted: 02/15/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Manubriosternal joint (MSJ) disease is a rare cause of anterior chest pain but can be a major sign of systemic arthritic involvement. In patients with ankylosing spondylitis (AS), a type of systemic arthritis, chest pain can be due to MSJ involvement and can be improved by ultrasound-guided corticosteroid injection into the joint.
CASE SUMMARY A 64-year-old man visited our pain clinic complaining of anterior chest pain. There were no abnormal findings on lateral sternum X-ray, but arthritic changes in the MSJ were observed on single-photon emission computed tomography-computed tomography. We performed additional laboratory tests, and he was finally diagnosed with AS. For pain relief, we performed ultrasound-guided intra-articular (IA) corticosteroid injections into the MSJ. After the injections, his pain nearly resolved.
CONCLUSION For patients complaining of anterior chest pain, AS should be considered, and single-photon emission computed tomography-computed tomography can be helpful in diagnosis. In addition, ultrasound-guided IA corticosteroid injections may be effective for pain relief.
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Affiliation(s)
- Min-Hee Choi
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Mokdong Hospital, Seoul 07985, South Korea
| | - In-Young Yoon
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Mokdong Hospital, Seoul 07985, South Korea
| | - Won-Joong Kim
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Mokdong Hospital, Seoul 07985, South Korea
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Miyoshi Y, Misaki K. Tietze's syndrome presenting as enthesitis diagnosed by ultrasound: A case report. Mod Rheumatol Case Rep 2023; 7:223-226. [PMID: 35284937 DOI: 10.1093/mrcr/rxac022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/01/2022] [Accepted: 03/10/2022] [Indexed: 01/07/2023]
Abstract
Tietze's syndrome (TS) is an inflammatory disorder characterised by painful, non-suppurative swelling in the sternocostal or sternoclavicular joint. The aetiology of TS is unknown. Herein, we described a case of isolated enthesitis in the sternocostal joint in a 42-year-old male patient whose clinical course led to the diagnosis of TS. A 42-year-old male Japanese patient (HLA-B27 negative) presented with chronic anterior chest wall pain. Mild swelling and tenderness were found in the right, third sternocostal joint (rt.3STCJ). No other arthralgia was present. Ultrasonography (US) of the rt.3STCJ showed hypoechoic thickening and power Doppler signal in the anterior radiate sternocostal ligament with mild synovial hypertrophy of the STCJ. US also depicted cortical bone erosion at the sternum with neovascularisation. Magnetic resonance imaging with T2-weighted short-tau inversion recovery showed high signal intensity in the bone marrow of the sternum and adjacent soft tissue around the rt.3STCJ. Based on these findings, TS with the enthesitis in the rt.3STCJ was diagnosed. The patient received a US-guided corticosteroid injection, and the symptoms completely resolved 10 months later. Enthesitis may cause TS. US is a readily available, sensitive imaging technique useful for diagnosing TS.
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Affiliation(s)
- Yuji Miyoshi
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Kenta Misaki
- Department of Rheumatology, Kita-Harima Medical Center, Hyogo, Japan
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Wu WT, Galluccio F, Lin TS, Chang KV, Özçakar L. Scanning before injection for costochondritis: A case report of ultrasound imaging of Hodgkin's lymphoma with chest wall invasion. Int J Rheum Dis 2023; 26:164-167. [PMID: 36239043 DOI: 10.1111/1756-185x.14464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 09/10/2022] [Accepted: 10/01/2022] [Indexed: 01/04/2023]
Abstract
Non-traumatic costochondritis, which manifests as pain and tenderness over the anterior chest wall, may be associated with inflammatory arthritis affecting the upper costochondral and sternocostal joints. Local corticosteroid injection is helpful for recalcitrant cases and ultrasound guidance may not be routinely used by experienced rheumatologists. We report a female patient with pain over the right upper parasternal area with gradual swelling near the first costosternal junction. The ultrasound examination revealed a hyper-vascular mass, which was proven to be Hodgkin's lymphoma. We want to emphasize the importance of using ultrasound for guiding injection for costochondral lesions which facilitated the detection of a tumor invading the chest wall in our case.
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Affiliation(s)
- Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Felice Galluccio
- Division of Rheumatology, Medical-Geriatric Department, University Hospital AOU Careggi, Florence, Italy.,MoMaRC Morphological Madrid Research Center, Ultradissection Group, Madrid, Spain.,Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Ting-Syuan Lin
- Division of Rheumatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan.,Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Muacevic A, Adler JR, Pacheco L. Bemoan My Collarbone: A Case of Costocondral Junction Syndrome Complicated by Methicillin Sensitive Staphylococcus aureus Sternoclavicular Osteomyelitis and Septic Arthritis. Cureus 2023; 15:e34108. [PMID: 36699106 PMCID: PMC9870702 DOI: 10.7759/cureus.34108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 01/24/2023] Open
Abstract
A 35-year-old female with a past medical history of untreated Hepatitis-C, and a history of intravenous (IV) drug use initially presented to the emergency department with chief complaints of gradual worsening sharp, constant left-sided chest pain with no radiation starting three weeks before presentation. In the emergency department (ED), she was afebrile, normotensive, and tachycardia with 99% oxygen saturation on room air. A physical exam revealed a well-developed Caucasian female, alert and oriented with moderate distress. Respiratory exam with symmetrical bilateral excursions without wheezes, crackles, or rhonchi. On cardiovascular exam, she was tachycardic with a regular rhythm without murmurs, rubs, or gallops. There was a 2 x 2 cm tender erythematous swelling on the left sternal border inferior to the clavicle. The neck was supple and negative for Jugular Venous Distension (JVD). Neurologically grossly intact. Abnormal laboratory findings included leukocytosis with neutrophilic predominance. The patient received intravenous (IV) antibiotics with broad-spectrum vancomycin, cefepime, and azithromycin and underwent computed tomography angiography (CTA) chest, revealing a 26.8 mm x 26.5 mm left anterior subapical pleural-based pulmonary mass-like lesion with central hypoattenuation in surrounding ground-glass changes. Biopsy of the left subapical pulmonary lesion results showed chronic inflammatory infiltrate. Unfortunately, the patient left the hospital against medical advice after supportive care and pain control. Our patient's history of intravenous drug use and active Hepatitis-C infection were typical risk factors associated with invasive infections. In the clinical context, leukocytosis with hypo-attenuated pulmonary lesion should raise suspicion for septic emboli, localized abscess pocket, infection by atypical organisms, infective endocarditis, and malignancy which was considered upon initial assessment.
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Daniels SP, Viers CD, Blaichman JI, Ross AB, Tang JY, Lee KS. US-guided Musculoskeletal Interventions of the Body Wall and Core with MRI and US Correlation. Radiographics 2021; 41:2011-2028. [PMID: 34623945 DOI: 10.1148/rg.2021210050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chest, abdominal, and groin pain are common patient complaints that can be due to a variety of causes. Once potentially life-threatening visceral causes of pain are excluded, the evaluation should include musculoskeletal sources of pain from the body wall and core muscles. Percutaneous musculoskeletal procedures play a key role in evaluating and managing pain, although most radiologists may be unfamiliar with applications for the body wall and core muscles. US is ideally suited to guide these less commonly performed procedures owing to its low cost, portability, lack of ionizing radiation, and real-time visualization of superficial soft-tissue anatomy. US provides the operator with added confidence that the needle will be placed at the intended location and will not penetrate visceral or vascular structures. The authors review both common and uncommon US-guided procedures targeting various portions of the chest wall, abdominal wall, and core muscles with the hope of familiarizing radiologists with these techniques. Procedures include anesthetic and corticosteroid injection as well as platelet-rich plasma injection to promote tendon healing. Specific anatomic structures discussed include the sternoclavicular joint, costochondral joint, interchondral joint, intercostal nerve, scapulothoracic bursa, anterior abdominal cutaneous nerve, ilioinguinal nerve, iliohypogastric nerve, genitofemoral nerve, pubic symphysis, common aponeurotic plate, and adductor tendon origin. Relevant US anatomy is depicted with MRI correlation, and steps to performing successful safe US-guided injections are discussed. Confidence in performing these procedures will allow radiologists to continue to play an important role in diagnosis and management of many musculoskeletal pathologic conditions. ©RSNA, 2021.
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Affiliation(s)
- Steven P Daniels
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, New York, NY 10016 (S.P.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (C.D.V., A.B.R., J.Y.T., K.S.L.); and Department of Medical Imaging, University of Toronto, Scarborough Health Network, Scarborough, ON, Canada (J.I.B.)
| | - Charles D Viers
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, New York, NY 10016 (S.P.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (C.D.V., A.B.R., J.Y.T., K.S.L.); and Department of Medical Imaging, University of Toronto, Scarborough Health Network, Scarborough, ON, Canada (J.I.B.)
| | - Jason I Blaichman
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, New York, NY 10016 (S.P.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (C.D.V., A.B.R., J.Y.T., K.S.L.); and Department of Medical Imaging, University of Toronto, Scarborough Health Network, Scarborough, ON, Canada (J.I.B.)
| | - Andrew B Ross
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, New York, NY 10016 (S.P.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (C.D.V., A.B.R., J.Y.T., K.S.L.); and Department of Medical Imaging, University of Toronto, Scarborough Health Network, Scarborough, ON, Canada (J.I.B.)
| | - Joseph Y Tang
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, New York, NY 10016 (S.P.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (C.D.V., A.B.R., J.Y.T., K.S.L.); and Department of Medical Imaging, University of Toronto, Scarborough Health Network, Scarborough, ON, Canada (J.I.B.)
| | - Kenneth S Lee
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, New York, NY 10016 (S.P.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (C.D.V., A.B.R., J.Y.T., K.S.L.); and Department of Medical Imaging, University of Toronto, Scarborough Health Network, Scarborough, ON, Canada (J.I.B.)
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Local treatment of pain in Tietze syndrome: A single-center experience. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:239-247. [PMID: 34104518 PMCID: PMC8167461 DOI: 10.5606/tgkdc.dergisi.2021.21120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/29/2020] [Indexed: 11/30/2022]
Abstract
Background
In this study, we present our experiences with local injections of triamcinolone and prilocaine in patients diagnosed with Tietze syndrome.
Methods
Between January 2016 and January 2019, a total of 28 patients (12 males, 16 females; median age: 33 years; range, 21 to 51 years) who were diagnosed with TS in our clinic were retrospectively analyzed. Triamcinolone hexacetonide and prilocaine hydrochloride were injected into painful joints. At first week, pain sensation of the patients was recorded using the Pain Rating Scale developed by the British Pain Society. Pain was also assessed at one, two, and three weeks after injections qualitatively and based on physical examination.
Results
At one week, the pain severity before the local injection treatment was above average the pain-related discomfort rates, and the response was quite favorable after the treatment (p=0.005 and p=0.001, respectively). A statistically significant rating was observed for treatment response and success (p=0.003). Totally 75% of the patients experienced more than 70% reduction in pain level after the injection.
Conclusion
Our treatment approach involving injection of a mixture of steroid and a local anesthetic provides a rapid relief from pain, irrespective of age, sex, or employment status in patients diagnosed with Tietze syndrome.
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Tietze syndrome. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.729803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rossi F, Martinoli C, Murialdo G, Schenone A, Grandis M, Ferone D, Tagliafico AS. The primary role of radiological imaging in the diagnosis of rare musculoskeletal diseases. Emphasis on ultrasound. J Ultrason 2019; 19:187-192. [PMID: 31807323 PMCID: PMC6856777 DOI: 10.15557/jou.2019.0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 07/18/2019] [Indexed: 12/20/2022] Open
Abstract
Objective: In July 2017 a multidisciplinary clinical Center specialized in rare diseases was activated. A rare disease can involve the musculoskeletal system. A multimodality musculoskeletal imaging approach allows for a rapid diagnosis. The purpose of this study was to assess when musculoskeletal radiology, ultrasound in particular, plays a primary role in the diagnostic path of a rare disease. Methods and materials: The Center included a list of 621 main rare diseases. Pathologies in which radiology has a primary diagnostic role were extracted from the list. From September 2017 to January 2018 all conditions involving the musculoskeletal system, including the peripheral nervous system, were systematically evaluated by one radiologist. The second radiologist, an official consultant of the Center, verified the list for consistency. Descriptive analysis was performed. Results: A total of 101/621 (16%) rare diseases can be diagnosed for the first time in the diagnostic path of the patient with medical imaging. A total of 36/101 (36%) rare diseases involve the musculoskeletal system. A total of 14/36 (39%) are pediatric diseases, 10/36 (28%) are adult age diseases, while 12/36 (33%) diseases affect all ages. A total of 23/36 (64%) of the selected rare diseases could be diagnosed with MRI, 19/36 (53%) with CT, 23/36 (64%) with X-ray, 9/36 (25%) with an US, and 1/36 (3%) with PET. Conclusions: Musculoskeletal imaging could be important for a non-invasive diagnosis in up to 36/101 (36%) rare diseases, as well as for outcome prediction, especially in pediatrics. Musculoskeletal imaging plays a crucial role in the diagnosis of rare diseases and could strongly influence the clinical pathway. Ultrasound is crucial in up to 25% of patients with rare diseases affecting the musculoskeletal system.
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Affiliation(s)
- Federica Rossi
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
| | - Carlo Martinoli
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giovanni Murialdo
- Department of Internal Medicine, Policlinico San Martino University Hospital, University of Genoa, Genoa, Italy
| | - Angelo Schenone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genova, Genoa, Italy
| | - Marina Grandis
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genova, Genoa, Italy
| | - Diego Ferone
- Endocrinology, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genua, Włochy
| | - Alberto Stefano Tagliafico
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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