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Painful swelling of the clavicle
  1. Federico Poropat1,
  2. Martina Bevacqua2,
  3. Rita Giorgi1,
  4. Daniela Dibello1,
  5. Elisabetta Cattaruzzi1,
  6. Egidio Barbi1,2
  1. 1 Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
  2. 2 University of Trieste, Trieste, Italy
  1. Correspondence to Dr Federico Poropat, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, TS 34137, Italy; federico.poropat{at}burlo.trieste.it

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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).

Figure 1

Ultrasound of the right sternoclavicular joint showing an enlargement of the articular capsule filled of hypoechoic inflammatory tissue collected between the two bone heads (red arrows).

QUESTION 1:

Which of the following do you think is the diagnosis in this patient?

  1. Infective osteomyelitis

  2. Chronic recurrent multifocal osteomyelitis (CRMO)

  3. Tietze syndrome (TS)

  4. Primary chest wall tumour

QUESTION 2:

Which is the next diagnostic step to confirm the clinical hypothesis?

  1. Bone biopsy

  2. CT scan

  3. MRI

  4. Bone …

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