Higoumenakis sign (clavicle)

Last revised by Daniel J Bell on 6 Jan 2020

The Higoumenakis sign is the unilateral enlargement of the sternal end of the clavicle in patients with late congenital syphilis. It was originally described as a clinical sign on physical examination but can also be recognized on chest radiograph 5.

Treponema pallidum becomes readily localized in the lymphatic spaces and may remain in the connective tissues without manifestation in childhood. Through mechanical movement of the dominant hand of the patient, the treponemata are reactivated and their toxins produce chronic periostitis which results in hyperostosis.

Described in 1927 by Gregorios "George" Higoumenakis (1895-1983), Greek dermatologist 3.

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