Case Report
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Dec 28, 2014; 6(12): 928-931
Published online Dec 28, 2014. doi: 10.4329/wjr.v6.i12.928
Tuberculous osteomyelitis/arthritis of the first costo-clavicular joint and sternum
Prasan Patel, Robin R Gray
Prasan Patel, Faculty of Medicine, Health Science Centre Foothills Campus, University of Calgary, Calgary AB T2N 4N1, Canada
Robin R Gray, Department of Diagnostic Imaging, Foothills Medical Centre, Calgary AB T2N 2T9, Canada
Author contributions: Patel P and Gray RR contributed substantially to the conception and design, acquisition of data, and analysis and interpretation of data and drafted the article, revised it critically for important intellectual content and gave final approval of the version to be published and agreed to act as a guarantor of the work;
Correspondence to: Robin R Gray, MD, FRCPC, Clinical Professor, Department of Diagnostic Imaging, Foothills Medical Centre, 1403 29 Street NW, Calgary AB T2N 2T9, Canada. rrgray470@gmail.com
Telephone: +1-403-9441969 Fax: +1-403-9442549
Received: July 18, 2014
Revised: September 1, 2014
Accepted: November 7, 2014
Published online: December 28, 2014
Processing time: 164 Days and 8.4 Hours
Abstract

A young Somali immigrant presents with a two-year history of a large, firm, painful right anterolateral chest wall sternal mass. The patient denied any history of trauma or infection at the site and did not have a fever, erythematous lesion at the site, clubbing, or lymphadenopathy. A lateral chest radiograph demonstrated a low density mass isolated to the subcutaneous soft tissue overlying the sternum, ribs and clavicle. Computed tomography (CT) with contrast demonstrated a cystic lesion in the right anterolateral chest wall deep to the pectoralis muscle. Enhanced CT of the chest demonstrated sclerosis and destruction of the rib and costochondral joint and manubrio-sternal joint narrowing. Ultrasound-guided biopsy and aspiration returned 500 cc of purulent, cloudy yellow, foul-smelling fluid. Acid-fact bacilli stain and the nucleic acid amplification test identified and confirmed Mycobacterium tuberculosis. A diagnosis of tuberculous osteomyelitis/septic arthritis was made and antibiotic coverage for tuberculosis was initiated.

Keywords: Infectious diseases; Tuberculosis; Sternum; Osteomyelitis; Radiology; Medicine in developing countries

Core tip: Clinicians must maintain a high index of suspicion of Mycobacterium tuberculosis in the immigrant population and other high-risk groups, and must be considered a causative agent of fevers in the retuning traveller. TB osteomyelitis/arthritis is much more indolent clinically and radiologically than bacterial osteomyelitis/arthritis, and therefore, a high index of suspicion must be maintained in individuals immigrating and who have compromised immune function.