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 recognised on chest radiograph 5.
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Pathology
Treponema pallidum becomes readily localised 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.
History and etymology
Described in 1927 by Gregorios "George" Higoumenakis (1895-1983), Greek dermatologist 3.
Differential diagnosis
- condensing osteitis of the clavicle
- sternoclavicular hyperostosis
- sternoclavicular osteoarthritis
- low-grade chronic osteomyelitis
- Tietze syndrome
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