Chronic reactive multifocal osteomyelitis (CRMO) - clavicle

Case contributed by Dr Jeremy Jones

Presentation

Left sided clavicular swelling and pain. Left arm numbness and times and parasthesia. No vascular symptoms.

Patient Data

Age: 10 years
Gender: Female

The medial portion of the left clavicle is expanded and the upper border is illdefined. Appearances are concerning for a bone tumor with agressive features. Further imaging with MRI is suggested.

Medial clavicular expansion with ill-defined enhancing edema and surrounding soft tissue mass. Cortical loss and agressive features.

Medial clavicular hyperostosis.

As demonstrated on the x-ray, the clavicle is expanded medially, but there is no surrounding inflammatory change as a result of successful treatment.

Case Discussion

Mono-ostotic disease with claviclular expansion and surroudning inflammatory change. The differential is between an agressive bone tumor (e.g. Ewing sarcoma), LCH, osteomyelitis and CRMO.

Biopsy returned inflammatory cell only.

Diagnosis of CRMO was made and there was symptomatic improvement on treatment. Follow up imaging demonstrates reduction in the inflammatory change around the clavicle.

 

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Case information

rID: 56406
Published: 30th Oct 2017
Last edited: 26th Jan 2019
Inclusion in quiz mode: Included

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