Presentation
History of a manubrial bone graft as a sequela of crush trauma several years ago. Now presents with intermittent upper chest pain and tenderness, with pyrexia.
Patient Data
Multilocular expansile lesion occupies the entire manubrium. It has a heterogeneously lytic-sclerotic matrix, exhibits moderate post-contrast heterogeneous enhancement, and contains internal foci of fluid density. The lesion is associated with mild destruction, periosteal reaction, subcutaneous edema, and reactive axillary lymphadenopathy. It abuts the sternal angle and extends to the sternoclavicular articulation.
Bilateral focal edema and enhancement of the overlying pectoralis muscle tendons suggest acute enthesitis.
Case Discussion
The radiological features suggest sternal bone graft chronic inflammation and infection in favor of chronic osteomyelitis.
A history of fever, reactive lymphadenopathy, and increased inflammatory markers support the diagnosis.
The differential diagnosis includes:
benign bone tumors including a giant cell tumor, and malignant transformation thereof
metastasis
tuberculous osteomyelitis; however, the lungs are normal, with no evidence of pulmonary tuberculosis
The management plan included specific antibiotic treatment with an option of curettage with bone graft or total resection with autologous rib reconstruction.
The patient did not continue imaging in our center during his treatment, so follow-up imaging is unavailable.
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