Anne Grethe Jurik (Ed.)
Imaging of the Sternocostoclavicular Region
Anne Grethe Jurik (Ed.)
Imaging of the
Sternocostoclavicular Region
With 101 Figures and 1 Table
123
Anne Grethe Jurik, MD, DMSc
Associate Professor, Consultant and Director of Research, Department of Radiology
Aarhus University Hospital Noerrebrogade 44
DK-8000 Aarhus C Denmark
E-mail: jurik@dadlnet.dk
ISBN 10 3-540-33147-6 Springer Berlin Heidelberg New York ISBN 13 978-3-540-33147-6 Springer Berlin Heidelberg New York Library of Congress Control Number: 2006929195
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V
The sternocostoclavicular region often presents diagnostic challenges for both the clinician and the radiologist. It is commonly involved in rheumatologic disorders, sometimes with pain referred to areas distant from the joints. This potentially can lead to delayed diagnosis. In addition, the region is difficult to visualise by conven- tional radiography implying the need for more demanding examinations to con- firm the disorder. As a result the region has generally not achieved the attention it merits by radiologists.
The purpose of this book is to give a survey of sternocostoclavicular disorders and their imaging based on the literature and the authors’ experience.
Anne Grethe Jurik Aarhus, Denmark
Preface
VII
I DEVELOPMENT OF THE STERNOCOSTOCLAVICULAR REGION
1 Bones, Cartilages and Joints . . . . 3
1.1 Introduction . . . . 3
1.2 Sternum, Including Manubriosternal Joint . . . . 3
1.3 Clavicle . . . . 8
1.4 Joints and Costal Cartilages . . . . 8
1.5 Conclusions . . . . 9
References . . . . 9
II NORMAL ANATOMY AND VARIANTS 2 Bones and Cartilages . . . . 13
2.1 Introduction . . . . 13
2.2 Sternum, Including Manubriosternal Joint . . . . 14
2.3 Clavicle . . . . 21
2.4 Cartilages and Their Articulation . . . . 23
2.5 Age Determination . . . . 25
2.6 Conclusions . . . . 26
References . . . . 26
3 Sternoclavicular Joints . . . . 29
3.1 Introduction . . . . 29
3.2 Macroscopic Anatomy . . . . 29
3.3 Microscopic Anatomy . . . . 31
3.4 Appearance at Imaging . . . . 33
3.5 Conclusions . . . . 35
References . . . . 35
Contents
Contents VIII
III BIOMECHANICS OF THE STERNOCOSTOCLAVICULAR REGION
4 Biomechanics of Joints and Cartilages . . . . 39
4.1 Introduction . . . . 39
4.2 Sternoclavicular Joints . . . . 39
4.3 Manubriosternal Joint . . . . 40
4.4 Sternocostal Joints . . . . 41
4.5 Conclusions . . . . 42
References . . . . 42
IV IMAGING TECHNIQUES AND PROCEDURES 5 Conventional Radiography and Tomography . . . . 45
5.1 Conventional Radiography . . . . 45
5.2 Conventional Tomography . . . . 47
5.3 Conclusions . . . . 47
References . . . . 47
6 Computed Tomography . . . . 49
6.1 Introduction . . . . 49
6.2 Technical Aspects . . . . 50
6.3 Normal Computed Tomography Appearance of the Sternocostoclavicular Region . . . . 51
6.4 Indications for Computed Tomography . . . . 54
6.5 Conclusions . . . . 55
References . . . . 55
7 Magnetic Resonance Imaging . . . . 59
7.1 Introduction . . . . 59
7.2 Technical Aspects . . . . 60
7.3 Normal Magnetic Resonance Imaging Appearance of the Sternocostoclavicular Region . . . . 61
7.4 Indications for Magnetic Resonance Imaging . . . . 62
7.5 Conclusions . . . . 66
References . . . . 66
8 Ultrasonography . . . . 69
8.1 Introduction . . . . 69
8.2 Technical Aspects . . . . 69
Contents IX
8.3 Normal Ultrasonography Appearance of the Sternocostoclavicular Region 71
8.4 Indications for Ultrasonography . . . . 71
8.5 Conclusions . . . . 74
References . . . . 74
9 Radionuclide Imaging . . . . 77
9.1 Introduction . . . . 77
9.2 Technical Aspects . . . . 78
9.3 Normal Appearance of the Sternocostoclavicular Region . . . . 78
9.4 Indications for Radionuclide Imaging . . . . 79
9.5 Conclusions . . . . 81
References . . . . 81
V CLINICAL PROBLEMS 10 Congenital and Developmental Abnormalities . . . . 85
10.1 Introduction . . . . 85
10.2 Pectus Deformities . . . . 85
10.3 Sternal Fusion Anomalies . . . . 88
10.4 Other Sternal Abnormalities . . . . 90
10.5 Clavicular Abnormalities . . . . 90
10.6 Conclusions . . . . 92
References . . . . 92
11 Traumatic and Post-traumatic Disorders . . . . 95
11.1 Introduction . . . . 95
11.2 Soft Tissue Injuries . . . . 96
11.3 Anterior Costal Fractures . . . . 97
11.4 Costal Cartilage Injuries . . . . 98
11.5 Sternal Fractures . . . 101
11.6 Sternoclavicular Dislocations . . . 103
11.7 Manubriosternal Dislocations . . . 107
References . . . 107
12 Seronegative Arthritis and Sternocostoclavicular Syndromes . . . 113
12.1 Introduction . . . 113
12.2 Ankylosing Spondylitis . . . 115
12.3 Osteoarthropathy Associated with Pustulosis Palmoplantaris . . . 119
12.4 Psoriatic Arthritis . . . 127
Contents X
12.5 Reactive Arthritis . . . 130
12.6 Enteropathic Arthropathy . . . 132
12.7 SAPHO, Sternocostoclavicular Hyperostosis and Other “Syndromes” . . . 134
12.8 Conclusions . . . 136
References . . . 136
13 Predominant Osseous Inflammatory Lesions . . . 143
13.1 Introduction . . . 143
13.2 Chronic Recurrent Multifocal Osteomyelitis . . . 144
13.3 Adult Osteoarthropathy . . . 153
13.4 Terminology . . . 158
13.5 Conclusions . . . 159
References . . . 160
14 Other Rheumatic Inflammatory Disorders . . . 165
14.1 Introduction . . . 165
14.2 Rheumatoid Arthritis . . . 165
14.3 Gout . . . 167
14.4 Pseudogout – Chondrocalcinosis . . . 168
14.5 Monarthritis . . . 168
14.6 Other Disorders . . . 171
14.7 Conclusion . . . 172
References . . . 172
15 Degenerative Joint Disorders, Including Condensing Osteitis . . . 177
15.1 Introduction . . . 177
15.2 Osteoarthritis of the Sternoclavicular Joint . . . 177
15.3 Condensing Osteitis . . . 181
15.4 Conclusions . . . 190
References . . . 190
16 Infectious Disorders . . . 193
16.1 Introduction . . . 193
16.2 Pyogenic Infections . . . 194
16.3 Tuberculosis . . . 197
16.4 Differential Diagnoses . . . 203
16.5 Conclusion . . . 203
References . . . 204
17 Primary Bone Tumours . . . 207
Contents XI
17.1 Introduction . . . 207
17.2 Primary Malignant Bone Tumours . . . 208
17.3 Primary Benign Tumours . . . 214
17.4 Tumour-like Lesions . . . 218
17.5 Management of Primary Bone Tumours of the Sternocostoclavicular Region . . . 220
17.6 Conclusion . . . 225
References . . . 226
18 Other Malignant Disorders . . . 229
18.1 Introduction . . . 229
18.2 Malignant Soft Tissue Tumours and Allied Disorders . . . 230
18.3 Myeloproliferative and Allied Disorders . . . 238
18.4 Conclusion . . . 242
References . . . 242
19 Miscellaneous Disorders . . . 245
19.1 Introduction . . . 245
19.2 Metabolic Disorders . . . 245
19.3 Amyloidosis . . . 246
19.4 Synovial Osteochondromatosis . . . 246
19.5 Postoperative Disorders . . . 247
19.6 Spontaneous Atraumatic Subluxation . . . 247
19.7 Other Disorders . . . 247
19.8 Conclusions . . . 250
References . . . 250
Subject Index . . . 251
XIII
Yasuaki Arai, MD, PhD
Divisions of Diagnostic Radiology and Nuclear Medicine, National Cancer Centre Hospital, 104-0045 Tokyo, Japan
Richard M. Blaquiere, MD
Department of Radiology, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
Hirokazu Chuman, MD
Division of Orthopedics, National Cancer Centre Hospital, Tokyo, Japan
Giuseppe Guglielmi, MD
Professor, Department of Radiology, Scientific Institute Hospital “Casa Sollievo della Sofferenza”, Viale Cappuccini 1, 71013 San Giovanni Rotondo, Italy
Stephen P. Harden, MD
Department of Radiology, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
Anne Grethe Jurik, MD Department of Radiology,
Aarhus University Hospital, Noerrebrogade 44, DK-8000 Aarhus C, Denmark
Tetsuo Maeda, MD
Divisions of Diagnostic Radiology and Nuclear Medicine, National Cancer Centre Hospital, 104-0045 Tokyo, Japan
Mototaka Miyake, MD
Divisions of Diagnostic Radiology and Nuclear Medicine, National Cancer Centre Hospital, 104-0045 Tokyo, Japan
List of Contributors
Contributors XIV
Mariano Scaglione, MD
Emergency and Trauma CT Section, Department of Radiology, Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
Flemming Brandt Soerensen, MD, DMSc
Professor, Department of Pathology, Aarhus University Hospital, Noerrebrogade 44, DK-8000 Aarhus C, Denmark
Ukihide Tateishi, MD, PhD
Divisions of Diagnostic Radiology and Nuclear Medicine, National Cancer Centre Hospital, 104-0045 Tokyo, Japan
Michele Tonerini, MD
Department of Emergency Radiology, S. Chiara Hospital, Via Bonanno Pisano, 56100 Pisa, Italy
Umio Yamaguchi, MD
Division of Orthopedics, National Cancer Centre Hospital, Tokyo, Japan
XV
AS Ankylosing spondylitis CRMO Chronic recurrent multifocal
osteomyelitis CRP C-reactive protein CT Computed tomography CVC Central venous catheter ESR Erythrocyte sedimentation rate FDG 18F-fluorodeoxyglucose FOV Field of view
Gd Gadolinium
ISCCO Intersternocostoclavicular ossification
MPR Multiplanar reconstruction MRI Magnetic resonance imaging MSCT Multislice computed tomography MSJ Manubriosternal joint
OA Osteoarthritis
PAO Pustulotic arthro-osteitis PET Positron emission tomography PPP Pustulosis palmoplantaris
RA Rheumatoid arthritis ReA Reactive arthritis
SAPHO Synovitis, acne, pustulosis, hyperostosis and osteitis SCC Sternocostoclavicular
SCCH Sternocostoclavicular hyperostosis SCJ Sternoclavicular joint
SCoJ Sternocostal joint SpA Spondylarthropathy
SPECT Single-photon emission computed tomography
STIR Short-tau inversion recovery (MR sequence)
T1 FS T1-weighted fat suppressed (MR sequence)
T2 FS T2-weighted fat suppressed (MR sequence)
VIP Volume intensity projection (CT projection)
Abbreviations
