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At least 433 records · Page 24Linked to original sources
PubMed2004

Ectopic hamartomatous thymoma: a clinicopathologic and immunohistochemical analysis of 21 cases with data supporting reclassification as a branchial anlage mixed tumor.

This report describes the clinicopathologic and immunohistochemical findings in 21 cases of a highly distinctive tumor with a strong predilection for the lower neck region of adult males. Our study group consisted of 20 males and one female. The patients were 28 to 79 years old (mean age, 47 years; median age, 40 years), and they presented with solitary, lobular or multilobular masses ranging in size from 2.0 to 19.0 cm in greatest dimension (mean size, 5.1 cm; median, 4 cm). The tumors principally involved the lower neck region, usually in close proximity to the sternoclavicular joint. The preoperative duration of the lesions ranged from 2 months to 30 years. Histologically, the tumors were typically well marginated and composed of plump spindled cells, delicate spindled cells, mature adipose tissue, and epithelial cells, including both squamous and glandular elements. Epithelial-lined cysts were a focal finding in most cases and measured up to 2 cm in greatest dimension. Mitotic counts for the tumors ranged from 0 to 7 mitotic figures per 50 high power fields (mean mitotic count, 1.1 mitotic figures per 50 HPFs). Our immunohistochemical analysis revealed a complex immunophenotype with a diverse keratin profile. The plump spindled cells had a myoepithelial phenotype, as evidenced by the coexpression of keratins (5, 5/6, and 14), alpha-smooth muscle actin, CD10, and to a lesser extent, calponin. No compelling evidence for thymic differentiation was observed. The patients were initially managed by biopsy or partial resection (n = 4), simple local excision (n = 16), or an unspecified procedure (n = 1). Clinical follow-up of > or =3 years was available for 10 patients (48%). Two patients had recurrent disease, but there were no metastases or tumor-related deaths. A derivation from sequestered branchial epithelium is likely, but evidence for a thymic component is tenuous, at best. Our data support reclassification of this distinctive process as a branchial anlage mixed tumor. The differential diagnosis includes conventional mixed tumors of skin adnexal or salivary gland origin, synovial sarcoma, a peripheral nerve sheath tumor variant, and cystic teratoma.

Adult↗
PubMed2005

FDG uptake in a catheter-related thrombus simulating relapse of lymphoma.

FDG-PET imaging was performed because of suspected recurrence of lymphoma of the chest. There was an area of increased activity posterior to the left sternoclavicular joint, suspected of being a relapse. Workup showed a thrombus at the tip of a central venous line corresponding to the FDG uptake. This is explained by the inflammatory process involving and surrounding chronic thrombus. Focal activity in relation to the tip of a venous catheter is very likely to have a benign etiology. It is important to recognize this not to overdiagnose a malignancy. For a correct interpretation, it is necessary to know the patient's history and having access to current radiologic examinations.

Adolescent↗
PubMed1998

Four cases of pustulotic arthro-osteitis.

We describe four cases of pustulotic arthro-osteitis. All of them suffered from anterior chest wall symptoms, such as swelling and pain on the sternoclavicular joint, sternal angle area, sternocostal joint, and costochondral junction. Although chest X-ray findings were all normal, 99mTc-scintigraphy revealed increased uptake in the affected areas in all cases. Laboratory examinations including rheumatoid factor were negative or normal except for elevation of the erythrocyte sedimentation rate and C-reactive protein in 2 cases. After treatment with non-steroidal anti-inflammatory drugs and etretinate or topical PUVA, the skin lesions on the palms and soles and the arthro-osteitis were moderately improved. Pustulotic arthro-osteitis should be considered when a patient with pustulosis palmoplantaris complains of anterior chest wall pain and other joint pain.

Adult↗
PubMed2006

Pustulosis palmaris et plantaris with prominent hyperkeratosis of the soles.

A 50-year-old woman developed prominent hyperkeratosis on the soles and erythema of her extremities. In this instance it was clinically difficult to distinguish the palmoplantar lesions from psoriasis vulgaris. However, our case proved to be palmoplantar pustulosis (PPP) because, on histology, the extra-palmoplantar lesions showed none of the typical findings of psoriasis vulgaris, there was a history of sternoclavicular joint pain, and the lesions improved after tonsillectomy. Herein, we consider the relationship between prominent hyperkeratosis of the sole or palm in PPP and bacterial infection.

Biopsy↗
PubMed1977

Surgical repair of a large incomplete cleft sternum.

Congenital deformities of the chest are not uncommon, are frequently symptomatic, and are readily correctable. This applies particularly to malfusion of the manubrium and upper sternum, which results in a bony deficiency together with divarication of the sternomastoid muscles and the sternoclavicular joints. Such defects of the sternum are best corrected as soon after birth as possible. Two patients are reported who had such a defect, and the technique for a satisfactory repair is described.

Humans↗
PubMed1985

Osteomyelitis of the first rib presenting as a cold abscess nine months after subclavian venous catheterization.

Percutaneous subclavian catheterization has been associated with numerous complications including osteomyelitis of the clavicle and sternoclavicular joint. We report a case of staphylococcal aureus osteomyelitis of the first rib associated with subclavian vein catheterization performed for temporary right ventricular pacing. This case is unusual because of its involvement of the first rib, its late development, and its presentation as a cold chest wall mass.

Abscess↗
PubMed2006

[SAPHO syndrome].

We report two cases, one 23 and one 27 year old man, with several years background of sternal and sternoclavicular joints pain, respectively. The laboratory tests were normal. Based on the clinical, radiologic and scintigraphic findings, SAPHO syndrome was diagnosed. Bone scintigraphy makes it possible to obtain a whole body scan in a single whole body scan, and can be used for differential diagnosis of other osteoarticular diseases and for evolutive control and therapeutic response.

Accidents, Traffic↗
PubMed1993

Computed tomography in sternocostoclavicular hyperostosis.

Sternocostoclavicular hyperostosis is a rare but recognized entity characterized by new bone formation and ligamentous ossification which limits mobility of the sternoclavicular joints. Aetiology is obscure and debated. There may be considerable delay in establishing the diagnosis, even by specialists. In confirming the diagnosis plain radiography is of limited value but radionuclide bone scan and computed tomography (CT) may be helpful. Four cases are described to emphasize these points and illustrate the clinical and radiological features of the condition. High resolution CT with thin sections (5 mm or less) is the examination of choice for demonstrating the characteristic features and is essential if the condition is to be confirmed in its early stages when treatment might be more successful in delaying progression.

Adult↗
PubMed1990

A surgical approach to the cervicothoracic spine.

We describe a method for approaching the lower cervical and upper thoracic spine, the brachial plexus and related vessels. The method involves the elevation of the medial corner of the manubrium, the sternoclavicular joint, and the medial half of the clavicle on a pedicle of the sternomastoid muscle. We have used this exposure in 17 cases with few complications and good results. Its successful performance requires high standards of anaesthesia, surgical technique and postoperative care.

Adult↗
PubMed2000

Upper extremity injuries in the paediatric athlete.

Injuries to the upper extremity in paediatric and adolescent athletes are increasingly being seen with expanded participation and higher competitive levels of youth sports. Injury patterns are unique to the growing musculoskeletal system and specific to the demands of the involved sport. Shoulder injuries include sternoclavicular joint injury, clavicle fracture, acromioclavicular joint injury, osteolysis of the distal clavicle, little league shoulder, proximal humerus fracture, glenohumeral instability and rotator cuff injury. Elbow injuries include supracondylar fracture, lateral condyle fracture, radial head/neck fracture, medial epicondyle avulsion, elbow dislocation and little league elbow. Wrist and hand injuries include distal radius fracture, distal radial physeal injury, triangular fibrocartilage tear, scaphoid fracture, wrist ligamentous injury thumb metacarpalphalangeal ulnar collateral ligament injury, proximal and distal interphalangeal joint injuries and finger fractures. Recognition of injury patterns with early activity modification and the initiation of efficacious treatment can prevent deformity/disability and return the youth athlete to sport.

Adolescent↗
PubMed1994

Bone disease in adolescents with acne fulminans and severe cystic acne: radiologic and scintigraphic findings.

OBJECTIVE: Acne fulminans is an uncommon form of ulcerative acne with acute onset. It usually affects adolescent boys who have associated musculoskeletal pain and septic fever. Osteolytic bone lesions have been reported in these patients. Severe cystic acne occurs almost equally in both sexes, but it has a less dramatic clinical course than acne fulminans and rarely causes ulcerative skin lesions and systemic symptoms. In this study we investigated the imaging features of bone lesions associated with acne fulminans and determined if patients with severe cystic acne have similar bone lesions. SUBJECTS AND METHODS: From 1970 through 1991, 24 patients with acne fulminans were treated in the dermatologic departments of Finnish hospitals. Radiologic (plain radiographs or conventional tomograms) or scintigraphic data were available for 21 patients and analyzed retrospectively. For comparison, 20 consecutive patients with severe cystic acne were examined prospectively with scintigraphy. RESULTS: Ten patients (48%) with acne fulminans had lytic bone lesions on the radiographs, and the bone scans showed increased uptake in 14 patients (67%). Destructive lesions resembling osteomyelitis were seen in seven patients. The bones of the anterior chest wall were predominantly involved: sternum in four patients, clavicle in three patients, and acromion scapulae in one patient. Sternoclavicular hyperostosis was seen in six patients. Four patients had small lytic lesions in the epiphyseal growth plate or a periosteal reaction. Follow-up was performed in eight patients with acne fulminans and in seven revealed either normal findings or sclerosis and hyperostosis in the previously affected areas of the sternum and clavicles. Slightly increased uptake of radionuclide, usually in the sternum or around the sternoclavicular joints, was seen in nine patients with severe cystic acne, but these findings were regarded as normal and radiographs were not obtained. CONCLUSION: Lytic lesions in the bones of the anterior chest wall and in the epiphyseal growth plates are common in patients with acne fulminans, but do not seem to occur in patients with severe cystic acne. The prognosis of bone disease associated with acne fulminans appears to be good, and the chronic sequelae, if any, are mild sclerosis and hyperostosis of the affected bones. Acne fulminans should be added to the list of dermatoses associated with bone lesions detectable by radiologic and scintigraphic methods.

Acne Vulgaris↗
PubMed2005

[Innominate artery war injury].

AIM: A case is reported of successfully surgically treated explosive war injury to the innominate artery. CASE REPORT: A 26-year-old soldier was injured in combat by a fragment of mortar shell. In the field hospital, the wound gauze packing was applied, followed by orotracheal intubation and thoracic drainage. The soldier was admitted to MMA six hours later. Physical examination, on admission, revealed huge swelling of the neck, the absence of pulse in the right arm and the right common carotid artery. Chest x-ray revealed hemopneumothorax of the right side and the foreign metal body in the projection of the right sternoclavicular joint. Due to the suspicion of large vessel injury, a median sternotomy was immediately performed. Surgery revealed disrupted bifurcation of the right innominate artery, so the ligation was performed. Aortography was performed postoperatively, followed by the reconstruction of innominate bifurcation with synthetic grafts. Control aortography showed good graft patency, and the patient was discharged from the hospital in good general condition with palpable pulses and mild anisocoria as a sole neurological sequela. CONCLUSION: A rare and life-threatening injury was successfully managed, mainly due to the rational treatment carried out in the field hospital that helped the injured to survive and arrive to the institution capable of performing the most sophisticated diagnostic and therapeutic procedures.

Adult↗
PubMed1997

Unusual presentations of extrapulmonary tuberculosis in three hemodialysis patients.

We report three patients who received maintenance hemodialysis and suffered from extrapulmonary tuberculosis with unusual presentations. The first patient presented with fever of unknown origin. All studies showed negative findings except high erythrocyte sedimentation rate and high value of C-reactive protein. He failed to response to broad-spectrum antibiotics but showed a complete response to antituberculosis therapy. The second patient presented with right supraclavicular lymphadenopathy and weakness. Lymph node biopsy revealed caseating granuloma with positive acid-fast bacilli. The third patient presented with tumor mass of left sternoclavicular joint for which malignancy was suspected initially. Ultimately, tuberculosis was documented by histopathologic studies showing caseating granuloma. All three patients had normal findings of chest x-ray and did not have previous history of tuberculosis and diabetes mellitus.

Adult↗
PubMed1994

"Trap door" exposure of the cervicothoracic junction. Technical note.

This report describes a "trap door" exposure of the cervicothoracic junction. The method combines a standard anterior approach to the spine along the medial border of the sternocleidomastoid muscle with both a partial median sternotomy and an anterolateral thoracotomy. Transection of the clavicle is not required and the sternoclavicular joint is preserved. With this method, all important ventral paravertebral vessels, nerves, and associated soft tissue are fully identified and readily mobilized as needed. The method provides full bilateral anterior exposure from the C-4 through at least the T-3 vertebral levels, as well as unilateral anterolateral access to the upper thoracic spine.

Cervical Vertebrae↗
PubMed2006

Nontraumatic disorders of the clavicle.

Other than those resulting from trauma and arthritis, disorders of the clavicle are uncommon. Some nontraumatic disorders are found only in infancy and childhood, such as birth fracture, infantile cortical hyperostosis, congenital pseudarthrosis, cleidocranial dysplasia, and short clavicle syndrome. Other nontraumatic disorders occur in both children and adults; these include anterior subluxation of the sternoclavicular joint, Friedrich's disease, hypertrophic osteitis, chronic multifocal periosteitis and arthropathy, and osteomyelitis. Some nontraumatic clavicular disorders are found only in adults, such as distal osteolysis. Because the description and nomenclature of these disorders arise from several medical disciplines, they often are confusing. Until clear, distinguishing features are described, it is advisable to combine some of the entities. This is especially true of the nonsuppurative inflammatory disorders of the clavicle, which appear to fall under the heading of spondyloarthropathy. Treatment varies by disorder and may include symptomatic and expectant management, drug therapy, and nonsurgical or surgical treatment.

Adolescent↗
PubMed1977

Sternocostoclavicular hyperostosis: painful swelling of the sternum, clavicles, and upper ribs. Report of two new cases.

Five patients had persistent, pulling pain in the sternum, clavicles, and upper ribs that was exacerbated by cold and dampness. Clublike, symmetrical enlargement of the clavicles was seen and, in two patients, venous congestion of the upper half of the body. All patients had a constantly elevated erythrocyte sedimentation rate. Radiologically there was symmetrical hyperostosis of the sternal and middle portions of the clavicles, synostosis of the sternoclavicular joints, a widened and thickened sternum, and varying degrees of involvement of the upper ribs. X-ray findings did not change over several years. Phlebography showed bilateral subclavian vein occlusion in three patients and unilateral occlusion in one. Biopsies of the clavicles showed a characteristic hyperostotic sclerosis of the spongiosa. The cause of this sternocostoclavicular hyperostosis is unknown, but clinical, radiologic, and histologic findings indicate that it may represent a distinct, hitherto undescribed entity.

Aged↗
PubMed1999

An anterior approach to the cervicothoracic junction of the spine (modified osteotomy of manubrium sterni and clavicle).

Standard anterior approaches to the cervicothoracic junction of the spine provide inadequate exposure. For this reason, various techniques of exposure are developed. One of these is Sundaresan's technique in which a part of the manubrium sterni and medial clavicle is resected. This technique provides good visibility and working area at the lesion level but causes a significant bony defect. We modified Sundaresan's technique and did not damage the sternoclavicular joint. After decompression and fusion was completed, the osteotomized segment was replanted. We performed this technique in a case of Pott's disease and had no problem with union at the osteotomy sites.

Abscess↗