RESUMO
Anterior chest wall instability as a result of sternocostal non-union is a rare complication but can give rise to invalidating pain and cardiac arrhythmias. A woman in her 40s was referred to us with anterior chest wall pain and instability after a modified Ravitch procedure. Sternocostal pseudoarthrosis was seen for which multiple operations were performed which were complicated by low-grade infections. A patient-specific three-dimensional modelled and printed prostheses was used in an operation to both lift the sternum for pectus correction and to reconnect the sternum and the sternal costal junction to regain anterior chest wall stability.
Assuntos
Procedimentos de Cirurgia Plástica , Impressão Tridimensional , Esterno , Parede Torácica , Humanos , Feminino , Parede Torácica/cirurgia , Esterno/cirurgia , Adulto , Procedimentos de Cirurgia Plástica/métodos , Pseudoartrose/cirurgia , Pseudoartrose/diagnóstico por imagem , Tórax em Funil/cirurgia , Articulações Esternocostais/cirurgia , Articulações Esternocostais/diagnóstico por imagemRESUMO
Aim: To investigate the clinical effect of low-frequency pulsed electromagnetic fields (PEMFs) and Traditional Chinese Medicine (TCM) kneading manipulation in the treatment of perimenopausal women with sternocostal joint pain. Methods: A total of 80 perimenopausal women with osteoporosis (OP) with sternocostal joint pain were selected as participants in the study. The patients were assigned to either the control or the treatment group, with 40 patients in each group. Patients in the control group were treated with oral Aceclofenac sustained-release tablets, calcium carbonate and vitamin D3 tablets. The treatment group was treated with low-frequency pulsed electromagnetic fields and TCM kneading manipulation. Numerical rating scale (NRS) scores, bone mineral density (BMD) and blood calcium concentration were measured and recorded before and after treatment in both groups. Results: There were no significant differences in age, disease course, body mass index, smoking history, pretreatment NRS pain score, bone mineral density (BMD), or serum calcium concentration between the two groups (P > .05). There were statistically significant differences in pain levels between the two groups at 3 days and 1, 3 and 6 months after treatment (P < .05). BMD of the femoral neck was significantly different at 6 months after treatment (P = .016 treatment difference from Control at 6 months: 0.055; 95% CI, 0.009 to 0.097). There were significant differences in serum calcium concentration at the third and sixth month of treatment (P < .05 treatment difference from control at 3 days: 0.055; 95% CI: 0.036 to 0.074; treatment difference from Control at 6 months: 0.039; 95% CI: 0.019 to 0.059). Different treatment methods had significant differences in serum calcium levels at the third and sixth month. Conclusion: Low-frequency pulsed electromagnetic field and TCM kneading manipulation can effectively relieve the symptoms of thoracic and costal joint pain in the short term in the perimenopausal period, improve bone density and delay disease progression.
Assuntos
Cálcio , Campos Eletromagnéticos , Humanos , Feminino , Cálcio/farmacologia , Articulações Esternocostais , Medicina Tradicional Chinesa , Perimenopausa , Densidade Óssea , Dor , Artralgia/terapiaRESUMO
The pectoralis major fiber regions contribute uniquely to the mobility and the stability of the shoulder complex. It is unknown how age and sex influence the stiffness of these regions during volitional contractions, but this knowledge is critical to inform clinical interventions targeting the pectoralis major. The aim of the present study was to determine if the activation-dependent stiffness of the pectoralis major fiber regions differs between the sexes and if it is altered with age. Ultrasound shear wave elastography was used to acquire shear wave velocity from the clavicular and the sternocostal fiber regions of 48 healthy participants, including 24 younger (12 males, 12 females, mean ± SD age 25 ± 4.1 years) and 24 older adults (12 males, 12 females, 55 ± 3.6 years). Participants performed vertical adduction and horizontal flexion torques in neutral and 90° externally rotated shoulder positions, and one of the two shoulder abduction positions (60° and 90°) at varying torque magnitudes (passive, 15% and 30% of maximal voluntary contraction). Separate linear mixed-effects models were run for each fiber region and shoulder position to determine if the activation-dependent stiffness differed between the sexes and was altered in older adults. Age-related alterations in stiffness during volitional contractions were observed in both fiber regions and were dependent on the task. Alterations in activation-dependent stiffness due to age were more pronounced in females than males. Additionally, females had greater stiffness than males during volitional contractions in both fiber regions. The present findings provide the first line of evidence that the activation-dependent stiffness of the pectoralis major fiber regions is influenced by sex and changes with age.
Assuntos
Envelhecimento/fisiologia , Músculos Peitorais/fisiologia , Caracteres Sexuais , Adulto , Clavícula/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Articulações Esternocostais/fisiologia , Adulto JovemAssuntos
Cartilagem Costal/diagnóstico por imagem , Dispneia , Imageamento por Ressonância Magnética/métodos , Policondrite Recidivante , Caixa Torácica/diagnóstico por imagem , Articulações Esternocostais , Adulto , Diagnóstico Diferencial , Dispneia/diagnóstico , Dispneia/etiologia , Humanos , Masculino , Mediastino/diagnóstico por imagem , Policondrite Recidivante/diagnóstico , Policondrite Recidivante/fisiopatologia , Articulações Esternocostais/diagnóstico por imagem , Articulações Esternocostais/patologia , Traqueia/diagnóstico por imagem , Traqueia/patologiaAssuntos
Artrite Psoriásica/diagnóstico por imagem , Manúbrio/diagnóstico por imagem , Articulação Esternoclavicular/diagnóstico por imagem , Articulações Esternocostais/diagnóstico por imagem , Idoso , Artrite Psoriásica/tratamento farmacológico , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Articulação Sacroilíaca/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Parede Torácica/diagnóstico por imagemRESUMO
We aim to establish a Tunisian score for age estimation through the study of chest plate's radiographs of a Tunisian male sample. We have focused on the study of 128 chest plate radiographs of Tunisian male individuals. We have established a score of eight criteria. The total score ranges from 8 to 32. Three observers scored double-blind the X-ray films. We studied the correlation of each criterion as well as the total score with chronological age for each observer. We also tested the reproducibility and the repeatability of criteria and total score. We calculated the estimated age for each score. We studied the relationship between the estimated age and the chronological age. The correlation between the total score and the chronological age has been good for the three observers (0.746, 0.756 and 0.742). The total score gives an estimation of age with a standard deviation of ± 5.88 years and a confidence interval of 95%, the interval's width increases gradually from 6.9 years to 23 years.
Assuntos
Determinação da Idade pelo Esqueleto/métodos , Determinação da Idade pelo Esqueleto/estatística & dados numéricos , Articulações Esternocostais/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Autopsia , Criança , Método Duplo-Cego , Humanos , Masculino , Pessoa de Meia-Idade , Osteogênese , Estudos Prospectivos , Valores de Referência , Análise de Regressão , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Tunísia/etnologiaAssuntos
Antineoplásicos Imunológicos/efeitos adversos , Melanoma/tratamento farmacológico , Nivolumabe/efeitos adversos , Neoplasias Cutâneas/patologia , Espondilartrite/induzido quimicamente , Articulações Esternocostais/diagnóstico por imagem , Articulação Zigapofisária/diagnóstico por imagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Etoricoxib/uso terapêutico , Glucocorticoides/uso terapêutico , Humanos , Imageamento por Ressonância Magnética , Masculino , Melanoma/secundário , Pessoa de Meia-Idade , Prednisolona/uso terapêutico , Amplitude de Movimento Articular , Costelas/diagnóstico por imagem , Espondilartrite/diagnóstico por imagem , Espondilartrite/tratamento farmacológico , Resultado do TratamentoRESUMO
Prone ventilation is used to manage patients with refractory hypoxia in the critical care unit. Complex chest trauma and chest drains have been a considered relative contraindication to prone ventilation. To the best of our knowledge, it is hitherto unreported in patients having traumatic floating sternum and acute respiratory distress. We present a brief case report of a patient with floating sternum (complete disruption of sternum) managed successfully by prone position ventilation.
Assuntos
Tórax Fundido/terapia , Hipóxia/terapia , Posicionamento do Paciente/métodos , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório/terapia , Traumatismos Torácicos/terapia , Acidentes de Trânsito , Analgesia Epidural , Tubos Torácicos , Drenagem , Tórax Fundido/complicações , Hemotórax/complicações , Hemotórax/terapia , Humanos , Hipotensão/complicações , Hipotensão/terapia , Hipóxia/complicações , Masculino , Pessoa de Meia-Idade , Norepinefrina/uso terapêutico , Decúbito Ventral , Síndrome do Desconforto Respiratório/complicações , Articulações Esternocostais , Traumatismos Torácicos/complicações , Vasoconstritores/uso terapêuticoRESUMO
Age estimation is commonly of interest in a judicial context. In adults, it is less documented than in children. The aim of this study was to evaluate age estimation in adults using CT images of the sternal plastron with volume rendering technique (VRT). The evaluation criteria are derived from known methods used for age estimation and are applicable in living or dead subjects. The VRT images of 456 patients were analyzed. Two radiologists performed age estimation independently from an anterior view of the plastron. Interobserver agreement and correlation coefficients between each reader's classification and real age were calculated. The interobserver agreement was 0.86, and the correlation coefficients between readers classifications and real age classes were 0.60 and 0.65. Spearman correlation coefficients were, respectively, 0.89, 0.67, and 0.71. Analysis of the plastron using VRT allows age estimation in vivo quickly and with results similar than methods such as Iscan, Suchey-Brooks, and radiographs used to estimate the age of death.
Assuntos
Determinação da Idade pelo Esqueleto/métodos , Imageamento Tridimensional , Costelas/diagnóstico por imagem , Esterno/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cartilagem Costal/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Estudos Retrospectivos , Articulações Esternocostais/diagnóstico por imagem , Adulto JovemRESUMO
INTRODUCTION: Open surgical procedures in the treatment of pectus excavatum (PE) involve predetermined incisions in the parasternal cartilage and the bony ribs. For some procedures, the ribs are even dissected from the sternum for better sternal mobilization and thus better elevation of the funnel. Secure restoration of the sternocostal junction is then required, with the consequence that healing may be quite impaired. Patients may also subsequently suffer from sternocostal nonunion, for example, pseudarthrosis, and dislocated ribs, as well as pain and a recurrence of PE. MATERIALS AND METHODS: Patients underwent another open surgery with revision of the pseudarthrotic sternocostal junctions and sufficient mobilization of the anterior chest wall, followed by an open reduction and internal fixation using Matrix Rib titanium plates (Synthes, Oberdorf, Switzerland). This procedure consisted of elevating the anterior chest wall and fixing the ribs to the sternum. In 2011 and 2012, we studied this procedure, known as elastic stable chest repair (ESCR), in a series of 20 patients. The patients underwent clinical and ultrasound examinations and X-ray radiographs after the operation, after 6 weeks, and at 3- and 12-month intervals. RESULTS: Follow-up showed high patient tolerance, although a loose plate was observed in one patient and a broken plate in three patients. A stable union was achieved for all sternocostal pseudarthroses. PE improved highly significantly (p < 0.001), as the Haller index decreased from 3.6 (range: 2.7-6.6, standard deviation [SD]: 0.92) to 2.7 (range: 2.0-3.7, SD: 0.42). Pain in the anterior chest wall was significantly reduced after the operation in the majority of cases. All but one patient was mobilized already the day after the operation. CONCLUSIONS: ESCR in recurrent PE achieved functional stabilization of the anterior chest wall combined with satisfactory results.
Assuntos
Placas Ósseas , Tórax em Funil/cirurgia , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Pseudoartrose/cirurgia , Articulações Esternocostais/cirurgia , Adolescente , Adulto , Estudos de Coortes , Feminino , Seguimentos , Tórax em Funil/diagnóstico por imagem , Humanos , Instabilidade Articular/prevenção & controle , Masculino , Satisfação do Paciente , Pseudoartrose/diagnóstico por imagem , Radiografia Torácica/métodos , Reoperação , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Articulações Esternocostais/diagnóstico por imagem , Parede Torácica/anormalidades , Parede Torácica/cirurgia , Titânio , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: Some open surgical methods describe complete sternocostal dissection with subsequent resynthesis. Lack of consolidation with painful sternocostal instability and retrosternal dislocation of sternal rib tips are possible complications. MATERIALS AND METHODS: Seven patients with symptomatic unilateral sternocostal dislocation were included in this study. After diagnosis, confirmed by three-dimensional computed tomography (CT), patients underwent open surgery. All affected ribs were reset and fixed to the sternum with the aid of titanium implants. RESULTS: The patients had, on average, unilateral dislocation of 3.4 rib joints with 15.4 mm retrosternal dislocation, which was fixed with 2.3 plates. A titanium splint was also employed. The recurrent nature of the problem made procedures very time-consuming (average operation time: 3 hours 25 minutes). One patient suffered strong intraoperative bleeding requiring transfusion of blood products and access enlargement. Follow-up examinations showed high patient satisfaction (grade of 1.7; rating scale 1-6). Remaining rib instabilities were observed just as infrequently as were material failures. The sternocostal rib splint in the costal cartilage became loose and was removed. One patient exhibited a pectoral muscle asymmetry. No other complications were observed. CONCLUSION: The term "stairway phenomenon" describes the dislocation of sternocostal joints. Observed after open pectus excavatum correction it can trigger substantial physical complaints. Thus, preserving those joints during pectus repair is strongly recommended. Locking titanium plates are a safe alternative to sternocostal suture fixation and is characterized by high patient satisfaction.
Assuntos
Placas Ósseas , Tórax em Funil/cirurgia , Luxações Articulares/cirurgia , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/instrumentação , Articulações Esternocostais/cirurgia , Titânio , Adulto , Desenho de Equipamento , Feminino , Tórax em Funil/diagnóstico , Humanos , Luxações Articulares/diagnóstico , Luxações Articulares/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reoperação , Articulações Esternocostais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto JovemRESUMO
No disponible
Assuntos
Humanos , Masculino , Criança , Torcicolo/etiologia , Processo Mastoide/fisiopatologia , Articulações Esternocostais/fisiopatologiaRESUMO
Thoracic outlet syndrome may result from a posterior sternoclavicular (SC) joint subluxation, or an anterior SC joint subluxation after surgical fixation. This case report presents the physical therapy management of a patient with bilateral thoracic outlet syndrome (TOS) secondary to bilateral idiopathic anterior SC joint subluxation. A 16-year-old female presented with a 2-year history of numbness, tingling, and coldness in bilateral upper extremities, and intermittent headaches with occasional vision loss. Ipsilateral upper extremity symptoms were reproduced with cervical rotation and shoulder flexion and abduction from 90° to end of the range. All TOS tests were positive. Passive horizontal abduction, through the plane of scaption, produced anterior subluxation of the ipsilateral SC joint. Sustained posterior glides to the medial clavicle relieved all symptoms during shoulder flexion and the Adson's test. Interventions consisted of manual therapy, therapeutic exercise, and the trial of two orthoses. After 12 treatment sessions, the patient's symptoms resolved and she improved by 10 points on the Upper Extremity Functional Index. She had no reproduction of symptoms with the thoracic outlet special tests. She maintained a static hold for 90 sec at 90° shoulder flexion, 90° shoulder abduction, and full shoulder flexion without symptoms. The outcomes describe a successful intervention for a patient with bilateral TOS secondary to idiopathic bilateral anterior SC joint subluxation. This case suggests that SC joint dysfunction should be considered as a cause of TOS and should be screened during the initial examination.
Assuntos
Luxações Articulares/complicações , Modalidades de Fisioterapia , Articulações Esternocostais/fisiopatologia , Síndrome do Desfiladeiro Torácico/diagnóstico , Síndrome do Desfiladeiro Torácico/terapia , Adolescente , Fenômenos Biomecânicos , Avaliação da Deficiência , Feminino , Humanos , Luxações Articulares/diagnóstico , Luxações Articulares/fisiopatologia , Força Muscular , Aparelhos Ortopédicos , Exame Físico , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Síndrome do Desfiladeiro Torácico/etiologia , Síndrome do Desfiladeiro Torácico/fisiopatologia , Fatores de Tempo , Resultado do TratamentoRESUMO
Rib malformation and anatomical variations are not well known and are still often underdiagnosed. Usually, rib malformations are fortuitously discovered. We describe here the case of a girl, 4 years and 4 months old, who presented at the emergency unit for fever and an anterior tumefaction of the ribcage, without any other symptoms. She was eupneic with a normal pulmonary auscultation and viral tonsillitis with a negative streptococcus test. The thoracic tumefaction was parasternal, painless, and fixed and measured approximately 2.5 × 2cm. Ultrasound findings consisted of a duplicated and hypoechogenic hypertrophy of the sterno-costal cartilage of the 4th left rib. Magnetic resonance imaging (MRI) confirmed the diagnosis of chondral bifidity of the sterno-costal junction of the 4th left rib. Fever, due to the viral tonsillitis, disappeared after 4 days. Rib malformations are rare, often anterior, unilateral, and preferentially located on the 3rd or the 4th rib. The main malformative rib lesions are bifid ribs, rib spurs, and widened ribs. Very rarely, they can be associated with Gorlin-Goltz syndrome or with other malformations such as VATER complex. The main differential diagnoses of these rib malformations are traumatic, tumoral, and infectious etiologies. In case of tumoral diseases, the topography of the lesion focuses the etiologic diagnosis: whereas an anterior and cartilaginous lesion is always benign, a lateral or posterior lesion can be an Ewing sarcoma. Rib malformation investigation consists in meticulous questioning, a complete clinical examination looking for any associated anomaly, completed by basic imaging explorations such as plain thoracic radiography focused on the ribcage and ultrasound. Finally, complementary computerized tomography or preferably MRI, depending on the anatomic location of the lesion, confirms the final diagnosis, as presented in our case report, and removes any uncertainty.
Assuntos
Cartilagem Articular/anormalidades , Febre de Causa Desconhecida/etiologia , Achados Incidentais , Costelas/anormalidades , Articulações Esternocostais/anormalidades , Tonsilite/diagnóstico , Cartilagem Articular/patologia , Pré-Escolar , Feminino , Humanos , Imageamento por Ressonância Magnética , Costelas/patologia , Articulações Esternocostais/patologia , UltrassonografiaRESUMO
This study was aimed to determine the effects of respiratory phase, age, sex and body mass indexes (BMI) on the visibility and morphological characteristics of the diaphragmatic sternocostal triangle in normal adults shown by multi-detector computed tomography (MDCT). A total of 100 normal adults were consecutively recruited and scanned with 16-row MDCT at the end of deep expiration and inspiration. The visibility and morphological characteristics of diaphragmatic sternocostal triangle were observed. All cases were grouped according to the respiratory phase, age, sex and BMI, respectively. The visibility rates by MDCT among different types of sternocostal triangles at the inspiratory or the expiratory phases were calculated and compared, and the visibility rate was correlated with age, sex, and BMI, respectively. In addition, the CT features of diaphragmatic hernia (n=2) were recorded and analyzed. The visibility rate of trigonum sternocostal was 43% at the end of inspiration and 32% at the end of expiration. No difference was found in regard to age, gender and BMI (P > 0.05). Rupture of diaphragm and the features of adjacent abdominal organs into thoracic cavity were revealed clearly on multiplanar reformation (MPR) images of MDCT in 2 patients with diaphragmatic hernia. The visibility rates of diaphragmatic sternocostal triangle were associated with the respiratory movement. MPR on MDCT could be useful for revealing the anatomic structure of diaphragm and the radiological features of diaphragmatic hernia. Furthermore, double-phase scanning of MDCT provides feasible method for studying the physiologic information of diaphragm movement in normal status and abnormal status.
Assuntos
Diafragma/anatomia & histologia , Diafragma/diagnóstico por imagem , Articulações Esternocostais/diagnóstico por imagem , Tomografia Computadorizada Espiral/métodos , Adolescente , Adulto , Idoso , Feminino , Hérnia Diafragmática/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Respiração , Articulações Esternocostais/anatomia & histologia , Adulto JovemRESUMO
This study was aimed to determine the effects of respiratory phase, age, sex and body mass indexes (BMI) on the visibility and morphological characteristics of the diaphragmatic sternocostal triangle in normal adults shown by multi-detector computed tomography (MDCT). A total of 100 normal adults were consecutively recruited and scanned with 16-row MDCT at the end of deep expiration and inspiration. The visibility and morphological characteristics of diaphragmatic sternocostal triangle were observed. All cases were grouped according to the respiratory phase, age, sex and BMI, respectively. The visibility rates by MDCT among different types of sternocostal triangles at the inspiratory or the expiratory phases were calculated and compared, and the visibility rate was correlated with age, sex, and BMI, respectively. In addition, the CT features of diaphragmatic hernia (n=2) were recorded and analyzed. The visibility rate of trigonum sternocostal was 43% at the end of inspiration and 32% at the end of expiration. No difference was found in regard to age, gender and BMI (P > 0.05). Rupture of diaphragm and the features of adjacent abdominal organs into thoracic cavity were revealed clearly on multiplanar reformation (MPR) images of MDCT in 2 patients with diaphragmatic hernia. The visibility rates of diaphragmatic sternocostal triangle were associated with the respiratory movement. MPR on MDCT could be useful for revealing the anatomic structure of diaphragm and the radiological features of diaphragmatic hernia. Furthermore, double-phase scanning of MDCT provides feasible method for studying the physiologic information of diaphragm movement in normal status and abnormal status.
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Diafragma , Diagnóstico por Imagem , Hérnia Diafragmática , Diagnóstico por Imagem , Imageamento Tridimensional , Respiração , Articulações Esternocostais , Diagnóstico por Imagem , Tomografia Computadorizada Espiral , MétodosRESUMO
OBJECTIVE: To retrospectively evaluate the role of the various imaging techniques in the study of the sternocostoclavicular joint, in patients with spondyloarthropathies and other rheumatic conditions and to assess potential pitfalls in the radiological diagnosis. SUBJECTS AND METHODS: Thirty patients, 11 male and 19 female, mean age 45 years, with involvement of the sternocostoclavicular joint as part of rheumatologic disorders (psoriatic arthritis, ankylosing spondylitis, Tietze syndrome, SAPHO syndrome, and condensing osteitis of the clavicle) were studied. Conventional radiography, CT, MRI and bone scintigraphy were performed. The following imaging findings were evaluated: soft tissue swelling, bone sclerosis, cortical bone erosions, joint space narrowing, subchondral sclerosis, periosteal new bone formation, synovial reaction and intrarticular effusion. All the images were independently reviewed by two musculoskeletal radiologists. RESULTS: Conventional radiography demonstrated only sclerosis of the clavicula in 8 pts (26%) and the sternum in 3 pts (10%), cortical bone erosions in 7 pts (23%), joint space narrowing in 6 pts (23%) and periosteal bone formation in 2 pts (10%). At the CT examination sclerosis of the clavicula and the sternum was observed in 13 pts (44%), cortical bone erosions in 22 pts (76%), joint space narrowing in 10 pts (34%), ligament ossification in 12 pts (41%), subchondral sclerosis in 9 pts (34%) and periosteal bone formation in 10 pts (34%). The MRI was the most sensitive technique in the evaluation of the soft tissue swelling in 9 pts (56%), intrarticular effusion in 13 pts (81%) and synovial reaction in 13 pts (81%). Finally, bone scintigraphy showed an increased uptake at the sterno-costoclavicular joint in all patients who underwent the examination. CONCLUSION: The radiological evaluation of the anterior chest wall in patients with different rheumatic disorders represents a problem of difficult diagnostic evaluation both for the anatomic region complexity and for the variability of the radiographic findings. The integrated use of X-ray, CT, MRI and nuclear medicine is suggested to avoid misdiagnosis.
Assuntos
Imageamento por Ressonância Magnética , Cintilografia , Doenças Reumáticas , Espondiloartropatias , Articulação Esternoclavicular , Articulações Esternocostais , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Clavícula/diagnóstico por imagem , Clavícula/patologia , Diagnóstico Diferencial , Erros de Diagnóstico/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças Reumáticas/diagnóstico por imagem , Doenças Reumáticas/patologia , Espondiloartropatias/diagnóstico por imagem , Espondiloartropatias/patologia , Articulação Esternoclavicular/diagnóstico por imagem , Articulação Esternoclavicular/patologia , Articulações Esternocostais/diagnóstico por imagem , Articulações Esternocostais/patologia , Esterno/diagnóstico por imagem , Esterno/patologia , Adulto JovemRESUMO
Behcet's disease (BD) is a polysymptomatic and recurrent systemic vasculitis with a chronic course and unknown cause. Erosive arthropathy is extremely rare. We report a 52-year-old female patient with BD demonstrating bone erosion of the sternocostal joint.
Assuntos
Síndrome de Behçet/patologia , Articulações Esternocostais/patologia , Osso e Ossos/patologia , Feminino , Humanos , Pessoa de Meia-IdadeAssuntos
Articulação Esternoclavicular/patologia , Articulações Esternocostais/patologia , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Hiperostose Esternocostoclavicular/diagnóstico , Hiperostose Esternocostoclavicular/patologia , Masculino , Pessoa de Meia-Idade , Articulação Esternoclavicular/anatomia & histologia , Articulações Esternocostais/anatomia & histologia , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To evaluate the usefulness of magnetic resonance imaging (MRI) in Tietze's syndrome which, to our knowledge, has not previously been reported in the literature. METHODS: Twelve consecutive outpatients with clinical features of Tietze's syndrome underwent evaluation, including the anamnesis, clinical general examination, clinical evaluation of costosternal and sternoclavicular joints (SCJ) and biochemical and instrumental investigations. Twenty normal subjects age- and sex-matched to the patients' group were examined in a similar manner. MRI of costosternal and SCJ was performed using a 1.5 Tesla unit (Gyroscan NT 1.5 Philips, The Netherlands and GE Signa Excite HD, GE Healthcare, Milwaukee, Wis., USA). RESULTS: The MRI pattern of primary Tietze's syndrome was characterized as follows: enlargement and thickening of cartilage at the site of complaint (12/12 patients); focal or widespread increased signal intensities of affected cartilage on both TSE T2-weighted and STIR or FAT SAT images (10/12 patients); bone marrow oedema in the subcondral bone (5/12 patients); vivid gadolinium uptake in the areas of thickened cartilage, in the subcondral bone marrow and/or in capsule and ligaments (10/12, 4/12 and 7/12 patients respectively). CONCLUSION: Magnetic resonance is an excellent technique to evidence both the cartilage and bone abnormalities, therefore it represents the elective method in the investigation of primary Tietze's syndrome, due to its high sensitivity, diagnostic reliability and biological advantages thanks to the lack of ionizing radiation.