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Mohamed AI, Elgasim MEM, Markey G. Clostridium Perfringens Septic Arthritis of the Sternoclavicular Joint. J Emerg Med 2021; 61:169-171. [PMID: 33992492 DOI: 10.1016/j.jemermed.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Clostridium perfringens septic arthritis of the sternoclavicular joint has not been reported previously. CASE REPORT We present the case of a 70-year-old patient with a history of stage IV colon cancer who presented to the emergency department with chest and neck pain for 3 days. After assessment, he was discharged home on analgesics. Within 24 h he returned, critically ill with C. perfringens septic arthritis of the left sternoclavicular joint and septic shock. Why Should an Emergency Physician Be Aware of This? Emergency physicians should be aware of the possibility of C. perfringens sternoclavicular joint septic arthritis in patients with unexplained chest, shoulder, or neck pain, especially when associated with a history of colorectal carcinoma or immunosuppression. A finding of C. perfringens bacteremia should prompt a search for occult gastrointestinal malignancy.
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Affiliation(s)
- Ahmed I Mohamed
- Department of Emergency Medicine, University Hospital Waterford, Waterford, Republic of Ireland
| | | | - Gerard Markey
- Department of Emergency Medicine, University Hospital Waterford, Waterford, Republic of Ireland
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Abstract
RATIONALE Sternoclavicular joint septic arthritis is an unusual disease in healthy adults, and Staphylococcus aureus is the most common causative pathogen. The current treatment of choice is surgery with sternoclavicular joint resection and pectoralis flap closure, especially when the disease is complicated by osteomyelitis and abscess. PATIENT CONCERNS Here, we report a 76-year-old woman without risk factors who visited our hospital for pain and redness, swelling on the left anterior chest wall. DIAGNOSIS Magnetic resonance imaging showed infectious arthritis in the left SCJ, with multiple abscess pockets at the subcutaneous layer of anterior chest wall communicating with the joint cavity. Streptococcus agalactiae was isolated from blood culture. INTERVENTION She was treated with 6 weeks of antibiotic therapy. OUTCOMES After antibiotic treatment, she was successfully treated without recurrence. LESSONS Besides surgery, medical treatment should also be considered for sternoclavicular joint septic arthritis, depending on patient status and the causative pathogen. Physicians should be aware of this rare disease to facilitate its prompt diagnosis and management.
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Ali B, Shetty A, Qeadan F, Demas C, Schwartz JD. Sternoclavicular Joint Infections: Improved Outcomes With Myocutaneous Flaps. Semin Thorac Cardiovasc Surg 2020; 32:369-376. [DOI: 10.1053/j.semtcvs.2019.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/14/2019] [Indexed: 11/11/2022]
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Agarwal P, Agarwal N, Hansberry DR, Majmundar N, Goldstein IM. Sternoclavicular joint arthropathy mimicking radiculopathy in a patient with concurrent C4-5 disc herniation. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.100495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ghate S, Thabet AM, Gosey GM, Southern EP, Bégué RE, King AG. Primary Osteomyelitis of the Clavicle in Children. Orthopedics 2016; 39:e760-3. [PMID: 27280623 DOI: 10.3928/01477447-20160526-10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 07/22/2015] [Indexed: 02/03/2023]
Abstract
Osteomyelitis of the clavicle is a rare entity with a broad differential diagnosis and high potential for complications if not diagnosed promptly and treated appropriately. The threshold for surgical intervention should be low to prevent osteonecrosis and bony resorption. In addition, although rare, life-threatening complications have been reported. This report describes primary osteomyelitis of the clavicle that was diagnosed in a 22-month-old girl on her third clinical evaluation after 4 days of symptoms. She presented to a children's tertiary care emergency department with fever and acute pain and swelling of her right shoulder and arm. The diagnosis was confirmed through clinical, laboratory, and imaging studies including ultrasound; these revealed subperiosteal abscess formation, which may have developed in part as the result of a delayed diagnosis from the 2 prior emergency department visits. The patient was treated initially with intravenous antibiotics and underwent therapeutic as well as diagnostic needle-guided tissue aspiration under ultrasound guidance. This ruled out malignancy but was not curative, and the subperiosteal abscess recurred within 24 hours, prompting formal operative irrigation and debridement. The patient was seen for 12-month follow-up and has had no complications or evidence of recurrence. This case emphasizes the need for a high index of suspicion to prevent diagnostic delays as well as the importance of a low threshold for surgical debridement to minimize the potential for complications that could prolong the treatment course. [Orthopedics. 2016; 39(4):e760-e763.].
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Tanaka Y, Kato H, Shirai K, Nakajima Y, Yamada N, Okada H, Yoshida T, Toyoda I, Ogura S. Sternoclavicular joint septic arthritis with chest wall abscess in a healthy adult: a case report. J Med Case Rep 2016; 10:69. [PMID: 27015841 PMCID: PMC4808294 DOI: 10.1186/s13256-016-0856-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 03/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Septic arthritis of the sternoclavicular joint is rare. It can be associated with serious complications such as osteomyelitis, chest wall abscess, and mediastinitis. In this report, we describe a case of an otherwise healthy adult with septic arthritis of the sternoclavicular joint with chest wall abscess. CASE PRESENTATION A 68-year-old Japanese man presented to our hospital complaining of pain and erythema near the right sternoclavicular joint. Despite 1 week of oral antibiotics, his symptoms did not improve. Computed tomography revealed an abscess with air around the right pectoralis major muscle. After being transferred to a tertiary hospital, emergency surgery was performed. Operative findings included necrotic tissue around the right sternoclavicular joint and sternoclavicular joint destruction, which was debrided and packed open. Methicillin-susceptible Staphylococcus aureus was identified in blood and wound cultures. Negative pressure wound therapy and hyperbaric oxygen therapy were performed for infection control and wound healing. The patient's general condition improved, and good granulation tissue developed. The wound was closed using a V-Y flap on hospital day 48. The patient has been free of relapse for 3 years. CONCLUSIONS Septic arthritis of the sternoclavicular joint is an unusual infection, especially in otherwise healthy adults. Because it is associated with serious complications such as chest wall abscess, prompt diagnosis and appropriate treatment are required.
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Affiliation(s)
- Yoshihito Tanaka
- Department of Emergency and Disaster Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194 Japan
| | - Hisaaki Kato
- Department of Emergency and Disaster Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194 Japan
| | - Kunihiro Shirai
- Department of Emergency and Disaster Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194 Japan
| | - Yasuhiro Nakajima
- Department of Emergency and Disaster Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194 Japan
| | - Noriaki Yamada
- Department of Emergency and Disaster Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194 Japan
| | - Hideshi Okada
- Department of Emergency and Disaster Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194 Japan
| | - Takahiro Yoshida
- Department of Emergency and Disaster Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194 Japan
| | - Izumi Toyoda
- Department of Emergency and Disaster Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194 Japan
| | - Shinji Ogura
- Department of Emergency and Disaster Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194 Japan
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Dajer-Fadel WL, Ibarra-Pérez C, Borrego-Borrego R, Navarro-Reynoso FP, Argüero-Sánchez R. Descending necrotizing mediastinitis and sternoclavicular joint osteomyelitis. Asian Cardiovasc Thorac Ann 2014; 21:618-20. [PMID: 24570571 DOI: 10.1177/0218492312463570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Descending necrotizing mediastinitis is usually associated with cervical or odontogenic infections. We describe a patient with blunt trauma to the chest 2 years earlier, and a slowly developing chest wall hematoma 18 months prior to admission, complicated by chronic sternoclavicular joint osteomyelitis, eventually leading to descending mediastinitis. Thoracotomy with drainage of the mediastinal spaces and multiple procedures for the sternoclavicular joint infection were successful. The rarity of this association and undefined optimal management prompted this report.
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Affiliation(s)
- Walid L Dajer-Fadel
- Department of Cardiothoracic Surgery, General Hospital of Mexico, Mexico City, Mexico
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A case of strenoclavicular septic arthritis with mediastinitis managed conservatively and literature review. Indian J Thorac Cardiovasc Surg 2012. [DOI: 10.1007/s12055-012-0148-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Katabathina VS, Restrepo CS, Martinez-Jimenez S, Riascos RF. Nonvascular, nontraumatic mediastinal emergencies in adults: a comprehensive review of imaging findings. Radiographics 2012; 31:1141-60. [PMID: 21768244 DOI: 10.1148/rg.314105177] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Given their high frequency, mediastinal emergencies are often perceived as being a result of external trauma or vascular conditions. However, there is a group of nonvascular, nontraumatic mediastinal emergencies that are less common in clinical practice, are less recognized, and that represent an important source of morbidity and mortality in patients. Nonvascular, nontraumatic mediastinal emergencies have several causes and result from different pathophysiologic mechanisms including infection, internal trauma, malignancy, and postoperative complications, and some may be idiopathic. Some conditions that lead to nonvascular, nontraumatic mediastinal emergencies include acute mediastinitis; esophageal emergencies such as intramural hematoma of the esophagus, Boerhaave syndrome, and acquired esophagorespiratory fistulas; spontaneous mediastinal hematoma; tension pneumomediastinum; and tension pneumopericardium. Although clinical findings of nonvascular, nontraumatic mediastinal emergencies may be nonspecific, imaging findings are often definitive. Awareness of various nonvascular, nontraumatic mediastinal emergencies and their clinical manifestations and imaging findings is crucial for making an accurate and timely diagnosis to facilitate appropriate patient management.
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Affiliation(s)
- Venkata S Katabathina
- Department of Radiology, University of Texas Health Science Center, San Antonio, TX 78229, USA.
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Nusselt T, Klinger HM, Freche S, Schultz W, Baums MH. Surgical management of sternoclavicular septic arthritis. Arch Orthop Trauma Surg 2011; 131:319-23. [PMID: 20721567 PMCID: PMC3040322 DOI: 10.1007/s00402-010-1178-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Septic arthritis of the sternoclavicular joint (SCJ) is a rare condition and has many diagnostic and therapeutic standards. The purpose of this study was to evaluate our experience with surgical and diagnostic management to provide a surgical pathway to help surgeons treat this disease. METHOD We retrospectively reviewed five patients who were managed surgically between 1999 and 2007. All patients underwent structured diagnostic and treatment protocols. The functional outcome was evaluated using the Constant Score. PATIENTS The patients had the following underlying medical conditions: laryngeal cancer, port-explantation linked to a rectum carcinoma, spondylodiscitis, and brain stem infarct with reduced general condition; one patient had no underlying medical problems. Three patients underwent a simple incision, debridement and drainage, and two patients underwent an extended intervention with partial resection of the sternoclavicular joint. The mean duration of follow-up was 29 months (range 24-36 months). All patients had well-healed wounds without signs of reinfection. The Constant Score for the functional outcome at the time of the last follow-up was 76 points (range 67-93 points). All patients recovered completely from SCJ disease. CONCLUSION Our recommendations for the management of septic arthritis of the sternoclavicular joint include standard treatment steps and assessments. The early stages of infection can be managed by simple incision, debridement and drainage. In advanced stages of infection, a more radical intervention is preferable.
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Affiliation(s)
- Thomas Nusselt
- Department of Orthopaedic Surgery, University of Goettingen Medical Centre (UMG), Georg-August-University, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
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Multidetector CT scan in the evaluation of chest pain of nontraumatic musculoskeletal origin. Thorac Surg Clin 2010; 20:167-73. [PMID: 20378067 DOI: 10.1016/j.thorsurg.2009.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Acute nontraumatic chest pain is a common presenting symptom to the emergency department. Often, it is evaluated by MDCT with PE, aortic dissection, or coronary artery protocols. The parameters used for these MDCT protocols are very similar to those used in protocols for dedicated imaging of the musculoskeletal system. Thus, these studies are not only effective in evaluating for these traditional vascular causes of chest pain, but also in evaluating musculoskeletal causes of chest pain, including those of infectious, rheumatologic, and systemic causes. In essence, every MDCT of the chest is also a musculoskeletal examination of the chest and anyone interpreting these images must be familiar with the MDCT-imaging appearance of common musculoskeletal causes of acute nontraumatic chest pain.
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Hillen TJ, Wessell DE. Multidetector CT Scan in the Evaluation of Chest Pain of Nontraumatic Musculoskeletal Origin. Radiol Clin North Am 2010; 48:185-91. [DOI: 10.1016/j.rcl.2009.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Katsoulis IE, Bossi M, Damani N, Livingstone JI. Arthritis of the sternoclavicular joint masquerading as rupture of the cervical oesophagus: a case report. J Med Case Rep 2009; 3:40. [PMID: 19178739 PMCID: PMC2639601 DOI: 10.1186/1752-1947-3-40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Accepted: 01/29/2009] [Indexed: 11/15/2022] Open
Abstract
Introduction Sternoclavicular septic arthritis is a rare condition and accounts only for 1% of cases of septic arthritis in the general population. The most common risk factors are intravenous drug use, central-line infection, distant-site infection, immunosuppression, trauma and diabetes mellitus. This is a report of an unusual case where this type of arthritis was masquerading as rupture of the cervical oesophagus. Case presentation A 63-year-old man presented complaining of right neck pain and dysphagia following a bout of violent coughing. Physical examination revealed cellulitis extending from the right sternoclidomastoid region to the anterior upper chest. Computed tomography showed inflammatory changes behind the right sternoclavicular joint with mediastinitis and ipsilateral pleural effusion. These findings raised the suspicion of spontaneous rupture of the cervical oesophagus. Management involved jejunal feeding along with broad-spectrum antibiotics. The inflammation, however, relapsed after discontinuation of the antibiotics and this time, computed tomography pointed to a diagnosis of arthritis of the sternoclavicular joint. The patient responded completely to a 6-week course of oral penicillin, flucloxacillin and metronidazole. Conclusion Sternoclavicular arthritis is a rare condition that has been associated with a variety of predisposing factors. It may, however, occur in otherwise completely healthy individuals and should be included in the differential diagnosis of other inflammatory conditions of the neck and upper chest.
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Affiliation(s)
- Iraklis E Katsoulis
- Upper Gastrointestinal Surgery Unit, Watford General Hospital, Watford, Hertfordshire, UK .
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Cone LA, Lopez C, O'Connell SJ, Nazemi R, Sneider RE, Denker H. Staphylococcal septic synovitis of the sternoclavicular joint with retrosternal extension. J Clin Rheumatol 2006; 12:187-9. [PMID: 16891922 DOI: 10.1097/01.rhu.0000230477.74693.38] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bacterial arthritis of the sternoclavicular joint is an uncommon disorder caused by a variety of microorganisms. Both Gram-positive and Gram-negative bacteria have been identified as etiologies of an acute suppurative arthritis, whereas a few other bacteria such as mycobacteria and treponemes have been incriminated in chronic disease of the sternoclavicular joint. We recently treated a patient with staphylococcal synovitis of the sternoclavicular joint, which is the 24th recorded in the literature. His illness was complicated by a retrosternal abscess, soft tissue abscess of the chest, septic bursitis, and lumbosacral discitis. He recovered after 6 weeks of nafcillin therapy without any residual infection. Six previous patients with extension into the substernal space and mediastinum have been described. Staphylococcal infection of the sternoclavicular joint, although usually confined to the joint, can be associated with sepsis and metastatic abscess formation as well as substernal extension even in immunocompetent individuals.
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Affiliation(s)
- Lawrence A Cone
- Eisenhower Medical Center, Rancho Mirage, California 92270, USA.
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Dhulkotia A, Asumu T, Solomon P. Breast abscess: a unique presentation as primary septic arthritis of the sternoclavicular joint. Breast J 2005; 11:525-6. [PMID: 16297129 DOI: 10.1111/j.1075-122x.2005.00170.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Browne JA, Kravet SJ, Cosgarea AJ. Sternoclavicular joint infection and mediastinitis originally attributed to concomitant rotator cuff pathology. Orthopedics 2004; 27:1108-10. [PMID: 15553955 DOI: 10.3928/0147-7447-20041001-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- James A Browne
- Johns Hopkins School of Medicine, The Johns Hopkins University, Baltimore, MD, USA
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Akman C, Kantarci F, Cetinkaya S. Imaging in mediastinitis: a systematic review based on aetiology. Clin Radiol 2004; 59:573-85. [PMID: 15208062 DOI: 10.1016/j.crad.2003.12.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2003] [Revised: 12/10/2003] [Accepted: 12/14/2003] [Indexed: 10/26/2022]
Abstract
Mediastinitis refers to inflammation of the tissues located in the middle chest cavity. It can be secondary to infectious or non-infectious causes and depending on the aetiology may be acute or chronic. The majority of cases of acute mediastinitis are secondary to oesophageal perforation and open chest surgery. Less common causes include tracheal, bronchial perforation or direct extension of infection from adjacent tissues. Chronic or slowly developing mediastinitis mostly arise from tuberculosis, histoplasmosis, other fungal infections, cancer, or sarcoidosis. In a minority of cases the aetiology is lymphatic obstruction or an autoimmune disease. Radiological imaging plays an essential role in the diagnosis and therapeutic approach to mediastinitis. Generally, the initial radiological work-up includes radiographic studies either with or without contrast material. However, conventional chest radiography may be misleading in the diagnosis of mediastinitis. Cross-sectional imaging techniques are generally required for diagnosis and evaluation of the site and extent of mediastinal involvement. Computed tomography and magnetic resonance imaging may also guide the choice of the optimal therapeutic approach.
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Affiliation(s)
- C Akman
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
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18
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Abstract
We review 170 previously reported cases of sternoclavicular septic arthritis, and report 10 new cases. The mean age of patients was 45 years; 73% were male. Patients presented with chest pain (78%) and shoulder pain (24%) after a median duration of symptoms of 14 days. Only 65% were febrile. Bacteremia was present in 62%. Common risk factors included intravenous drug use (21%), distant site of infection (15%), diabetes mellitus (13%), trauma (12%), and infected central venous line (9%). No risk factor was found in 23%. Serious complications such as osteomyelitis (55%), chest wall abscess or phlegmon (25%), and mediastinitis (13%) were common. Staphylococcus aureus was responsible for 49% of cases, and is now the major cause of sternoclavicular septic arthritis in intravenous drug users. Pseudomonas aeruginosa infection in injection drug users declined dramatically with the end of an epidemic of pentazocine abuse in the 1980s. Sternoclavicular septic arthritis accounts for 1% of septic arthritis in the general population, but 17% in intravenous drug users, for unclear reasons. Bacteria may enter the sternoclavicular joint from the adjacent valves of the subclavian vein after injection of contaminated drugs into the upper extremity, or the joint may become infected after attempted drug injection between the heads of the sternocleidomastoid muscle. Computed tomography or magnetic resonance imaging should be obtained routinely to assess for the presence of chest wall phlegmon, retrosternal abscess, or mediastinitis. If present, en-bloc resection of the sternoclavicular joint is indicated, possibly with ipsilateral pectoralis major muscle flap. Empiric antibiotic therapy may need to cover methicillin-resistant Staphylococcus aureus (MRSA).
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Affiliation(s)
- John J Ross
- From Division of Infectious Diseases (JJR), Caritas Saint Elizabeth's Medical Center, Boston, Massachusetts, and Division of Infectious Diseases (HS), University of Iowa Hospitals, Iowa City, Iowa
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Sternoclavicular Joint Septic Arthritis Manifesting as a Neck Abscess: A Case Report. EAR, NOSE & THROAT JOURNAL 2003. [DOI: 10.1177/014556130308200818] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Septic arthritis of the sternoclavicular joint is an uncommon condition, and the diagnosis can be missed until a complication occurs. The sternoclavicular joint is more often involved in ankylosing spondylitis, degenerative arthritic conditions (i.e., rheumatoid arthritis and osteoarthritis), and primary and secondary metastatic conditions. The patient described in this case report came to the otolaryngology department on two occasions for treatment of a unilateral cutaneous neck abscess. The correct diagnosis was not made until the second visit. The author reviews the clinical course, diagnosis, and treatment of this uncommon disease.
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Affiliation(s)
- Richard J Hamilton
- Department of Emergency Medicine, Drexel University College of Medicine, Medical College of Pennsylvania Hospital, 3300 Henry Avenue, Philadelphia, PA 19129, USA
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21
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Klein MA, Spreitzer AM, Miro PA, Carrera GF. MR imaging of the abnormal sternoclavicular joint--a pictorial essay. Clin Imaging 1997; 21:138-43. [PMID: 9095391 DOI: 10.1016/s0899-7071(96)00040-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The sternoclavicular (SC) joint can be affected by a wide variety of pathologic conditions. Imaging is usually needed for diagnosis and staging. Although the use of magnetic resonance (MR) imaging has become indispensable in the evaluation of most joints, MR has received little attention in SC joint evaluation. Recently, however, it has been shown that detailed MR images of the normal SC joint can be obtained. This pictorial essay explores the differential diagnosis of the abnormal SC joint and helps to determine the role of MR imaging in the SC joint imaging algorithm.
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Affiliation(s)
- M A Klein
- Department of Radiology, Froedtert Hospital, Medical College of Wisconsin, Milwaukee 53226, USA
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González Muñoz JI, Córdoba Peláez M, Tébar Boti E, Téllez Cantero JC, Castedo Mejuto E, Varela de Ugarte A. [Surgical treatment of sternoclavicular osteomyelitis]. Arch Bronconeumol 1996; 32:541-3. [PMID: 9019315 DOI: 10.1016/s0300-2896(15)30691-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Osteomyelitis of the sternocosto-clavicular (SCC) articulation is a rare infection usually caused by Staphylococcus aureus and enterobacteria. It usually occurs in individuals with osteoarticular disease or predisposing factors. Prolonged antibiotic treatment and articular puncture are generally accepted. Authors do not agree on an established protocol. We report three cases of SCC septic arthritis in two previously healthy patients with two foci of infection (one perianal abscess and one dental extraction) and in one adult patient with Still's disease. Pain and intense inflammation was referred to the shoulder, with scarce leukocytosis and fever reaching 38 degrees C. The germs responsible were S. aureus, Bacteroides fragilis and B. oralis. Two of the patients had local, regional abscesses. Long-term antibiotic treatment failed in all cases and surgery for SCC resection and myoplasty of the pectoralis major muscle was required. Recovery was good and shoulder and arm mobility was excellent. We propose medical treatment and articular diagnostic-therapeutic puncture as the first line of therapy for this disease. When evolution is poor or when complications appear, such as abscesses or mediastinitis, we conclude that radical debridement and myoplasty of the pectoralis major muscle are indicated.
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Affiliation(s)
- J I González Muñoz
- Servicio de Cirugía Torácica y Cardiovascular, Clínica Puerta de Hierro, Madrid
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Abstract
Sternoclavicular septic arthritis is an uncommon clinical entity that is often misdiagnosed on initial presentation. It has generally been described in IV heroin users and immunocompromised hosts. We report the case of a 43-year-old woman with endstage liver disease who presented with a fever, a painful sternoclavicular joint, and gastrointestinal bleeding. The clinical presentation, diagnosis, and treatment of sternoclavicular septic arthritis are reviewed.
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Affiliation(s)
- C Guerra
- University of Rochester Medical Center, New York, USA
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Rubinstien E, Slavin J. Thymic abscess with bacteremia and manubriosternal pyarthrosis in a geriatric patient. Chest 1993; 103:962-4. [PMID: 8449107 DOI: 10.1378/chest.103.3.962] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
We describe a geriatric patient with acute substernal chest pain thought to be due to coronary heart disease, who was subsequently found to have Staphylococcus aureus bacteremia associated with infection of the thymus and manubriosternal joint. To our knowledge, this is the first report of (1) a thymic abscess in a geriatric patient, (2) a thymic abscess associated with bacteremia, (3) extra-articular extension of manubriosternal pyarthrosis, and (4) manubriosternal pyarthrosis in the geriatric age group.
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Affiliation(s)
- E Rubinstien
- Department of Medicine, Saint Francis Hospital and Medical Center, Hartford
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