Sternocostoclavicular hyperostosis. Nosological concepts

The term sternocostoclavicular hyperostosis groups affections of different pathogenicity. These result from an ossifying enthesiopathy, either inflammatory, isolated to the thoracic wall anteriorly or combined with a spondylarthropathy, particularly ankylosing spondylitis, or degenerative, the anterior thoracic hyperostosis usually being part of an ensheathing vertebral hyperostosis. A differential diagnosis is anterior thoracic hyperostosis due to an inflammatory osteopathy occurring in young patients and often associated with other bone lesions of pelvis and spine or long bones.     

Spinal hyperostosis as an important sign indicating spine injuries on postmortem computed tomography

Although spine injuries are not always detectable on postmortem computed tomography (PMCT), spinal hyperostosis, an important risk factor for spine injury, is relatively easily detectable on PMCT. We therefore examined the utility of the detection of spinal hyperostosis on PMCT as an indicator of spine injury. Full-body PMCT images of 88 autopsy cases with a bruise on the face or forehead but no identifiable skull fracture were reviewed prior to autopsy for the identification and classification of spinal hyperostosis. Spine injuries were observed in 56.0% of cases with spinal hyperostosis and 1.6% of cases without spinal hyperostosis. Among the cases with spinal hyperostosis, spine injuries were observed in 66.7% of cases at stage 2 or 3 and in 88.9% of cases at stage 3. Spine injuries were diagnosed on PMCT in 33.3% of cases prior to autopsy. A significant association was found between spinal hyperostosis and presence of spine injury that cannot be detected on PMCT, indicating that the identification of spinal hyperostosis on PMCT may assist in detecting spine injuries. This finding suggests that investigation of the presence of spine injury based on the identification of spinal hyperostosis on PMCT may assist in determining the correct cause of death by autopsy.     

Focal hyperostosis on CT of sinonasal inverted papilloma as a predictor of tumor origin

BACKGROUND AND PURPOSE: To evaluate the CT characteristics of focal hyperostosis in patients with sinonasal inverted papilloma and to correlate these characteristics with the detection of the origins of tumors. MATERIALS AND METHODS: Paranasal sinus and nasal cavity CT images of 76 patients were reviewed retrospectively to detect areas within which there was focal hyperostosis. We correlated the sites on the CT scans within which there was focal hyperostosis with the origin of the tumors described in the corresponding patient's medical records. We also evaluated the CT features of focal hyperostosis according to the origin of tumors. RESULT: Surgical evaluation of 55 lesions with focal hyperostosis in CT images revealed that 49 of these lesions coincided with the actual origin of tumor. The CT-based determination of the locations of the areas of focal hyperostosis corresponded to the actual tumor origin in 89.1% of cases. Especially in cases with focal hyperostosis within the frontal, maxillary, sphenoid, and posterior ethmoid sinuses, areas of focal hyperostosis corresponded to the origin of tumor without exception. In the evaluation of the CT features of focal hyperostosis, 2 patterns of localized bone thickening were noted. Plaquelike bone thickening was seen mainly when focal hyperostosis involved the lateral wall of the nasal cavity. On the other hand, cone-shaped bone thickening was seen only in the walls of the paranasal sinuses or the bony septum. CONCLUSIONS: A high correlation between the origin of the inverted papilloma and focal hyperostosis on CT might facilitate preoperative prediction of tumor origin by radiologists and rhinologists.     

Familial infantile cortical hyperostosis: an update

In 1961, the senior author reported 11 members of one family with infantile cortical hyperostosis. Since then, 10 new cases have occurred in this family resulting in a total of 21 cases. The incidence of infantile cortical hyperostosis in this family is as common today as it was two generations ago, and there has been no diminution in the incidence. Several patients with minimal or no clinical symptoms would have gone unrecognized had it not been for the family history of the disorder. On the basis of this study, infantile cortical hyperostosis is inherited as an autosomal dominant with variable penetrance.     

Bone imaging of sternocostoclavicular hyperostosis in palmoplantar pustulosis

Sternocostoclavicular hyperostosis is a rare syndrome that is characterized by hyperostosis and soft tissue ossification between the clavicles and the anterior part of the upper ribs. This syndrome frequently is found in the case of palmoplantar pustulosis (PPP), especially in Japan. There have been few published reports, however, of Tc-99m MDP bone imaging findings in PPP. Eleven patients with PPP who were suspected to have sternocostoclavicular hyperostosis were studied with Tc-99m MDP whole body bone imaging. Bone images were abnormal in 11 patients. Abnormal radionuclide concentrations were observed in the sternoclavicular, sternocostal, and manubriosternal joints, in the ribs, and in the sternum. Whole body imaging revealed radionuclide accumulations unexpectedly in other bones such as the vertebrae, femur, tibia, or sacroiliac joints in five of 11 cases. Radiographs were available in nine patients. Three chest radiographs were negative, and six showed various degrees of hyperostosis or sclerotic changes in sternoclavicular, sternocostal, or manubriosternal joints, or in the sternum or anterior upper ribs. These bone lesions usually were more prominent and more easily recognized with bone scintigraphy. Bone scintigraphy should be used as a routine procedure in patients with PPP who are suspected to have sternocostoclavicular hyperostosis.     

MR appearance of sternal hyperostosis

Sternal hyperostosis is characterized by prominent new bone formation and fibrosis with less pronounced areas of granulation tissue and round cell infiltration. In previously reported cases the process involved not only the sternum but adjacent bony areas as well. Depending upon the extent of disease, acquiring biopsy material for histologic analysis can be difficult. We report a case of sternal hyperostosis involving the sternum exclusively and extensively. Magnetic resonance imaging was useful in directing biopsy for optimal histologic yield. This unusual case of sternal hyperostosis is believed to be the result of an inflammatory process.     

Stress fracture of the clavicle associated with sternocostoclavicular hyperostosis

We report a case of stress fracture of the clavicle associated with sternocostoclavicular hyperostosis. A 60-year-old man sustained a stress fracture of the right clavicle with no history of trauma. On radiography, hyperostosis of the anterior chest wall and ankylosis of the sternoclavicular joint were evident in addition to the fracture. Fracture healing was uneventful after 2.5 months. Ankylosis of the sternoclavicular joint may have caused increased stress at the midshaft of the clavicle by daily activity or minor trauma. Such a fracture is a rare complication of sternocostoclavicular hyperostosis.     

Computed tomographic appearances of sternocostoclavicular hyperostosis

Computed tomographical analysis of sternocostoclavicular hyperostosis was performed in 27 patients. In the earliest stage hyperostosis occurred around the cartilaginous portion of the first ribs. The sternoclavicular joint space was preserved even in the late stage III of the disorder. These findings suggest that sternocostoclavicular hyperostosis develops around the costal cartilage including periosteum, perichondrium, and the ligamentous structures, and that the sternoclavicular joint is not primarily involved. It is also suggested that perichondritis and periostitis play important roles in the etiology of this disorder.     

The pattern of spinal and extraspinal hyperostosis in patients with ossification of the posterior longitudinal ligament and the ligamentum flavum causing myelopathy

Thirty one patients suffering from myelopathy associated with ossification of the posterior longitudinal ligament and ligamentum flavum of the spine have been investigated. The pattern of spinal and peripheral hyperostosis was recorded in each case. Flowing anterior vertebral hyperostosis and ligamentous ossification at the enthesis around the pelvis and hips were the most frequent associations, occurring in approximately 86% of patients. The distribution and incidence of the spinal and extraspinal hyperostosis in this series corresponds closely to the findings in diffuse idiopathic skeletal hyperostosis (DISH). The present findings indicate that patients suffering from cervical myelopathy and ossification of the posterior longitudinal ligament should be regarded as manifesting focal features of a more generalised disorder producing skeletal hyperostosis.     

Dysphagia caused by an anterior cervical osteophyte: case report

Cervical spondylosis and ankylosing hyperostosis of the cervical vertebrae are commonly asymptomatic. Dysphagia caused by cervical osteophyte formation is rare. We report a case of spondylotic dysphagia with striking radiographic findings. A massive anterior cervical hyperostosis was resected via the anterior cervical approach with excellent relief of dysphagia.     

Usefulness of bone imaging in diagnosis of sternocostoclavicular hyperostosis

Four patients with sternocostoclavicular hyperostosis showing characteristic abnormal uptake on bone imaging are described. Bone imaging was useful in the diagnosis of sternocostoclavicular hyperostosis.     

Hyperostosis cranii. Radiography and scintigraphy compared

The bone scintigrams of 52 women with radiographically proven hyperostosis cranii were examined specifically with regard to the endosteal lesions. It was confirmed that hyperostosis cranii exhibits a characteristic appearance at bone scintigraphy that is usually easy to recognize. By scoring the degree of hyperostotic changes and their scintigraphic activity according to a semiquantitative scale, an inverse relation between radiographic changes and scintigraphic activity was observed but could not be statistically proven. A tendency of more pronounced radiographic changes and a tendency of decreasing activity at bone scintigraphy with increasing age were also found. It is suggested that hyperostosis cranii starts in younger women and that the initial osseous turnover of the lesions is high. Successively, the metabolic activity decreases while the endosteal lesions increase, tending towards a stabilization of the process with increasing age.     

Autosomal dominant osteosclerosis.

Two cases of a craniotubular hyperostosis are presented. The radiographic features closely resemble Van Buchem disease (hyperostosis corticalis generalisata; endosteal hyperostosis, recessive type), including symmetrical and bilateral diaphyseal cortical thickening of the long and short tubular bones as well as sclerosis and thickening of the calvaria, mandible, shoulder and pelvic girdles, and thoracic cage. Unlike Van Buchem disease, no periosteal excresences are observed, alkaline phosphatase is normal, no basal foramina encroachment of the skull is present, and the genetic pattern is dominant inheritance. These cases possibly represent a separate disorder rather than a variant of Van Buchem disease.     

Hyperostotic esthesioneuroblastoma: CT and MR findings

Olfactory neuroblastoma is a malignant, slow growing, neurogenic tumor that originates in the olfactory mucosa of the upper nasal cavity. Its CT appearance, i.e., a soft tissue mass adherent to the cribriform plate usually with bone lysis, has been described. Two cases are presented in which this entity was associated with exuberant bony hyperostosis, a feature not previously reported. The differential diagnosis of nasoethmoid soft tissue masses with associated hyperostosis is reviewed.     

Diffuse skeletal hyperostosis in idiopathic hypoparathyroidism

A case of idiopathic hypoparathyroidism (IHP) is reported with extensive ligamentous and tendinous ossification and soft tissue calcification. The pertinent radiological features of IHP and the unusual findings in this case are reviewed together with similar previously reported cases. Whether IHP is a causative or aggravating factor in the aetiology of the skeletal changes is discussed with particular reference to their similarity to diffuse idiopathic skeletal hyperostosis (DISH). We conclude that, in patients with an ossifying diathesis, IHP acts as a stimulant resulting in exuberant skeletal hyperostosis that is indistinguishable from DISH.     

腰椎峡部裂并脊椎滑脱的MRI表现及影像学比较

目的 :探讨MRI在腰椎峡部裂并脊椎滑脱症中的诊断价值。方法 :分析总结 5 3例腰椎峡部裂并脊椎滑脱症的传统X线片、CT、MR扫描表现并进行比较。结果 :传统X线平片表现为腰椎滑脱、峡部裂、局部骨质增生硬化 ;CT表现为峡部裂、局部骨质增生硬化、韧带肥厚、椎管狭窄及矢状径增大 (双管征 )、椎间盘变形 ;MRI表现为峡部骨髓信号连续性中断、局部骨质呈T1、T2 低信号、韧带肥厚、腰椎滑脱、椎间孔变形 (双叶征 )、神经根卡压、节段性椎管扩张和狭窄。结论 :MR扫描对腰椎峡部裂并脊椎滑脱症的诊断具有重要的临床应用价值     

Spinal changes in association with sternocostoclavicular hyperostosis

A case of sternocostoclavicular hyperostosis was reported in a 63-year-old woman who had been followed for 15 years. Radiographic changes in the claviculo-sternal area were typical of this condition, and biopsy revealed abnormalities in the right clavicle and in the sternum compatible with infection. Radiographic changes in the thoracic and lumbar spine revealed findings compatible with infective spondylitis and a seronegative spondylarthropathy, respectively. The nature of these spinal changes as compared with those of diffuse idiopathic skeletal hyperostosis and seronegative spondylarthropathy is discussed.     

Sternocostoclavicular hyperostosis: a space-occupying lesion of the superior thoracic aperture

Sternocostoclavicular hyperostosis is a rare disease characterized by soft-tissue ossifications and hyperostosis of the clavicles, anterior segments of the upper ribs and sternum. These changes may imitate other disorders and thus may be misinterpreted. We present the radiologic appearances of this entity and discuss the diagnostic value of computerized tomography, magnetic resonance imaging and scintigraphy.     

Spinal hyperostosis in comparative pathology

Spinal hyperostosis, an anatomical and radiological concept primarily described in man, is characterized by enthesopathic bony overgrowth on vertebral bodies in the form of spurs or intervertebral bridges. It can also be part of a more diffuse enthesopathic condition, including the appendicular skeleton. These changes are distinct from those of osteoarthrosis. Similar changes can be observed in all kinds of mammals, independent of their type of locomotion (bipodic, quadrumanous, quadrupedic, or aquatic). An anatomical and radiological study is presented of six cases (with histological examination of two dogs and one horese, and observation of macerated specimens of one horse, one equida, and one whale). Comparative pathology allows for a better understanding of the concept of hyperostosis and, even more clearly than in man, this can be distinguished from that of discovertebral pathology although both conditions could be associated in older subjects. The knowledge of spinal hyperostosis in veterinary medicine could-as in man-be of interest to differentiate between this process and other features of vertebral pathology.     

Differential diagnosis of inflammatory spondylitis

Some of the causes of inflammatory spondylitis are described and their radiological differentiation discussed. These appearances are compared and contrasted with the hyperostoses of non-inflammatory spondylosis.The classical appearance of Marie-Strümpell ankylosing spondylitis is shown to be virtually indistinguishable from colitic spondylitis, except perhaps in degree. Spondylitis associated with psoriasis and Reiter's disease, however, presents a different pattern.The hyperostosis of hypophosphatemic osteomalacia may simulate ankylosing spondylitis and has led to misdiagnosis. Similarity is noted also between the non-inflammatory hyperostoses, particularly in the appendicular skeleton, including primary hypoparathyroidism and Forestier's spinal hyperostosis (diffuse idiopathic skeletal hyperostosis).