TY - JOUR T1 - Painful swelling of the clavicle JF - Archives of disease in childhood - Education & practice edition JO - Arch Dis Child Educ Pract Ed SP - 211 LP - 213 DO - 10.1136/archdischild-2018-315417 VL - 104 IS - 4 AU - Federico Poropat AU - Martina Bevacqua AU - Rita Giorgi AU - Daniela Dibello AU - Elisabetta Cattaruzzi AU - Egidio Barbi Y1 - 2019/08/01 UR - http://ep.bmj.com/content/104/4/211.abstract N2 - 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).Which of the following do you think is the diagnosis in this patient?Infective osteomyelitisChronic recurrent multifocal osteomyelitis (CRMO)Tietze syndrome (TS)Primary chest wall tumour Which is the next diagnostic step to confirm the clinical hypothesis?Bone biopsyCT scanMRIBone … ER -