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A 14-year-old boy was admitted for a painful swelling of the middle third of his right clavicle lasting 3 days. He denied any trauma and/or fever. Physical examination showed a soft swelling, without calor or hyperemia of the skin. Pain was exacerbated by bone percussion and by right arm abduction movements. Bone X-ray was normal, but an ultrasound showed enlargement with hypoechoic soft tissue and enhancement of the vascular signal with Doppler technique (figure 1). The blood tests were normal, with no elevation of erythrocyte sedimentation rate (ESR) and C reactive protein (CRP).
Which of the following do you think is the diagnosis in this patient?
Chronic recurrent multifocal osteomyelitis (CRMO)
Tietze syndrome (TS)
Primary chest wall tumour
Which is the next diagnostic step to confirm the clinical hypothesis?
Funding None declared.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
Correction notice This paper has been amended since it was published Online First. Figure 1 and figure 2 were in the wrong order. They have now been swapped around. The figure legends are correct.