Sternocostoclavicular hyperostosis is a chronic arthro-osteitis affecting mostly juxtasternal structures. It is characterized clinically by painfull swelling of the upper anterior chest wall and occasionally is associated with pustulosis palmaris
and
plantaris.
A 34-year-old female presented with upper anterior chest pain and low back pain. She was well until three months ago, then left shoulder pain and multiple pustule on both palms developed. She felt grradually exhausted in spite of symptomatic
medication
at drug store. Eight months before this admision she underwent an operation on the right sided breast due to a benign mass.
On examination there was no evidence of conjunctivitis or aphthous oral ulcer, tenderness on left sternoclavicular joint was noted and flextion of the left hip joint was limited because of pain in the joint area. Multiple pustules were noted in
the
palms of both hands, but it wasn't associated with nail change. The mammographs was normal. Plain radiographs of the spine showed disc space narrowing of seventh thoracic spine and spondylolysis on fifth lumbar vertebra. Radionuclide imaging with
99mTc-methylene diphosphonate of the bone showed multiple increased uptake on both sacroiliac joints, both first costochondral joints, left sternoclavicular joint, and eighth thoracic vertebra. Magnetic Resonance Imaging reavealed low signal
intensity
in medial end of the left clavicle with joint effusion and Schmorl's node in seventh thoracic disc space. Laboratory tests wee normal, except ESR 23mm/h.
In this case we think that careful clinical differential diagnosis of sternocostoclavicular hyperostosis should include sclerotic metastasis.
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