A 36 y.o. woman complained of a painful nodule on the L chest 2 weeks after an MVC

What could this be?

Our patient had a sternoclavicular joint infection unrelated to her car accident. She is an IV heroin user. With the increase in IV heroin use this type of infection is increasing in incidence.  This used to be a rare occurrence with 225 cases reported in the past 45 years but recently it has become more common.

 inflammation around the L sternoclavicular joint with distal clavicle osteo.

inflammation around the L sternoclavicular joint with distal clavicle osteo.

The sternoclavicular joint is composed of the medial head of the clavicle, the outer aspect of the manubrium and the cartilage of the first rib with great vessels lying immediately beneath.  The complications of sternoclavicular joint infection include: mediastinitis, osteomyelitis or chest wall abscess.

Of all sternoclavicular joint infections. 17% are found in IV drug users. Diabetics, patients with chronic renal failure  and patients with previous arthritis at the joint are more likely to get infections. It is postulated that  bacteria may enter the sternoclavicular joint from the adjacent valves of the subclavian vein or the joint may be infected by injecting  between the heads of the sternocleidomastoid muscle. En-bloc resectin of the sternoclavicular joint is indicated with a pectoralis muscle flap used to close the defect.

sternoclav joint inf2.JPG

Our patient underwent surgical debridement and is on long term antibiotics.  Her culture grew MSSA.

 

Muesse J, Blackmon S, Wllsworth W, Kim M. Treatment of sternoclavicular joint osteomyelitis with debridement and delayed resection with muscle flap coverage improved outcomes.   volume 2014. Surgery Research and Practice.  Article ID 747315  http://dx.doi.org/10.1155.2014/747315

Murga A, Copeland H, Hargrove R, et al. Treatment for sternoclavicular joint infections: a multi Our patient underwent surgical debridement and is on long term antibiotics. Her culture grew MSSA.

-institutional study. 2017. Journal of Thoracic Disease. Jun; 9(6):1503-1508.  Doi:10.21037/jtd2017.05.76

Ross J, Shamsuddin H. Sternoclavicular septic arthritis: review of 180 cases. 2004. Medicine May;84(3):139-48.