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Sternoclavicular joint septic arthritis

Case contributed by Bruno Di Muzio
Diagnosis certain

Presentation

Painful lump in the region of the left sternoclavicular joint.

Patient Data

Age: 55 years

MRI Left clavicle

mri

There is a cortical destruction of the sternoclavicular joint margins associated with adjacent bone marrow edema and enhancement, as well as an irregular fluid collection within the joint space. Extensive inflammatory changes noted within the adjacent soft tissues, including muscular edema, in particular of the pectoralis major and sternocleidomastoid muscles. Small soft tissue collection anterior to the clavicle 14 mm lateral to the joint. No soft tissue collections elsewhere. Multiple enlarged likely reactive left neck lymph nodes. The imaged neck vessels have preserved flow voids.

US Neck targeted for FNA

ultrasound

Thickening and hyperemia of the left sternocleidomastoid, in particular of the clavicular head. The patient is most tender over this region. Surrounding lymphadenopathy. Small effusion of the left sternoclavicular joint has bee sampled. 

Case Discussion

Imaging features are consistent with sternoclavicular joint septic arthritis.

 

MICROSCOPY

GRAM STAIN

  • Leukocytes +
  • Gram positive cocci +
  • Calcium pyrophosphate crystals detected - indicative of pseudogout.

CULTURE Staphylococcus aureus +++

 

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