Acquired hyperostosis syndrome: Spectrum of manifestations at the sternocostoclavicular region. Radiologic evaluation of 34 cases

Abstract

Thirty-four patients with chest wall hyperostosis, a condition which has been designated by various terms in the literature were evaluated radiologically. We prefer the name acquired hyperostosis syndrome (AHS), which we categorize into the complete, incomplete and possible form. In complete AHS, sternocostoclavicular hyperostosis is associated with axial and/or peripheral (endosteal, periosteal, enthesopathic, metaplastic) hyperostosis and with psoriasiform or acneform dermatosis. In addition, these three manifestations are accompanied by erosive or non-erosive peripheral and/or axial arthritis to a variable degree. Sometimes, concomitant findings which are consistent with ankylosing spondylitis are also to be found in the axial skeleton. AHS is manifested at 11 different sites on the anterior chest wall. Ossification forms of the costal cartilage, inflammatory enthesopathies (three different insertions) and focal hyperostoses as well as processes of remodelling of the ribs, clavicles and sternum which are described in detail have particular diagnostic significance. AHS can start simultaneously at one, two or several sites on the anterior chest wall. Conventional tomography (possibly supplemented by CT) is necessary for early diagnosis and for analysis of the various findings on the anterior chest wall.

Sternocostoclavicular Hyperostosis: A Review

“…Clinical manifestations SCCH very infrequently may be asymptomatic with radiographic findings only [Katz et al 1989] but in most cases the disorder presents with pain and palpable tenderness in the sternoclavicular region [Dihlmann and Dihlmann, 1991;Chigira and Shimizu, 1989]. Local swelling and warmth is almost always present [Chigira and Shimizu, 1989].…”

“…Tests for rheumatoid factor and other immunological tests are usually negative [Economou et al 1993]. Although patients of European descent may demonstrate a slightly increased prevalence of HLA-B27 positivity, no clear relationship to SCCH has been demonstrated [Dihlmann and Dihlmann, 1991].…”

“…Chigira and Shimizu added a stage 0 to the Sonozaki staging in which no ossification could be clearly demonstrated [Chigira and Shimizu, 1989]. Joint spaces in the sternoclavicular region initially are preserved, but as the disorder progresses radiographic evidence of erosive changes predominantly in the sternoclavicular joint may be detected [Fritz et al 1992;Dihlmann and Dihlmann, 1991]. Recognizing that ossification and hyperostotic changes occur beyond the sternoclavicular region, Fritz and colleagues further modified the Sonozaki staging in 1992 by adding the qualifiers of 'R' for concomitant involvement of multiple ribs and 'E' for concomitant extrasternal manifestations [Fritz et al 1992].…”

“…Salmonellosis, brucellosis, tuberculosis, staphylococcal infection, and syphilis are a few organisms that can cause infection of the sternoclavicular joint or a subacute osteomyelitis [Taylor and Dawes, 1992;Dehdashti and Siegel, 1989]. A pancoast tumor with local extension, thyroid cancer, lymphoma, or metastatic breast or prostate cancer should also be considered in any patient at risk for these neoplasias [Economou et al 1993;Dihlmann and Dihlmann, 1991;Katz et al 1989;Prevo et al 1989]. Aseptic necrosis of the clavicle (Friedrich's disease) and a healing fracture are other conditions to consider early in the disease course [Freyschmidt and Sternberg, 1998;Economou et al 1993].…”

Vertebral lesions associated with palmoplantar pustulosis

“…Most reports have suggested that sterno-costo-clavicular hyperostosis or nonspecific osteitis is a significant aetiology of PPP or, at least, is an important factor contributing to the cutaneous manifestations [4,5,13,15,16,23,31]. This osseo-arthro-cutaneous syndrome shows unique clinical manifestations which may correlate with each other during its lengthy course [8,9,14,18].…”