Manubriosternal Joint Research Articles

18F-Sodium fluoride PET-CT visualizes disease activity in chronic nonbacterial osteitis in adults.

Chronic nonbacterial osteitis (CNO) is a rare disease spectrum, which lacks biomarkers for disease activity. Sodium fluoride-18 positron emission tomography/computed tomography ([18F]NaF-PET/CT) is a sensitive imaging tool for bone diseases and yields quantitative data on bone turnover. We evaluated the capacities of [18F]NaF-PET/CT to provide structural and functional assessment in adult CNO. A coss-sectional study was performed including 43 adult patients with CNO and 16 controls (patients referred for suspected, but not diagnosed with CNO) who underwent [18F]NaF-PET/CT at our expert clinic. Structural features were compared between patients and controls, and maximal standardized uptake values (SUVmax [g/mL]) were calculated for bone lesions, soft tissue/joint lesions, and reference bone. SUVmax was correlated with clinical disease activity in patients. Structural assessment revealed manubrial and costal sclerosis/hyperostosis and calcification of the costoclavicular ligament as typical features associated with CNO. SUVmax of CNO lesions was higher compared with in-patient reference bone (mean paired difference: 11.4; 95% CI: 9.4-13.5; p < .001) and controls (mean difference: 12.4; 95%CI: 9.1-15.8; p < .001). The highest SUVmax values were found in soft tissue and joint areas such as the costoclavicular ligament and manubriosternal joint, and these correlated with erythrocyte sedimentation rate in patients (correlation coefficient: 0.546; p < .002). Our data suggest that [18F]NaF-PET/CT is a promising imaging tool for adult CNO, allowing for detailed structural evaluation of its typical bone, soft-tissue, and joint features. At the same time, [18F]NaF-PET/CT yields quantitative bone remodeling data that represent the pathologically increased bone turnover and the process of new bone formation. Further studies should investigate the application of quantified [18F]NaF uptake as a novel biomarker for disease activity in CNO, and its utility to steer clinical decision making.

Septic Arthritis of the Manubriosternal Joint in an Adolescent: A Case Report

Septic Arthritis of the Manubriosternal Joint in an Adolescent: A Case Report

Costovertebral and costotransverse joint involvement in spondyloarthritis.

Costovertebral (CV), costotransverse (CTr), sternoclavicular (SC), and manubriosternal (MS) joints are impacted in spondyloarthritis (SpA) patients; however, clinical aspects of these involvements require additional evaluation. A total of 281 SpA patients who had undergone chest computed tomography (CT) for any reason between 2010 and 2020 were included in the study. SpA patients were divided into three groups, ankylosing spondylitis (AS), non-radiographic axial SpA, and psoriatic arthritis. Thirty age- and sex-matched rheumatoid arthritis (RA) patients and 30 non-rheumatic disease individuals were selected for comparison. An experienced radiologist reviewed 24 CV, 20 CTr, 2 SC, and 1 MS joints from a thorax CT for each patient. All joints were classified as: normal (0); suspicious (1), mild (2), moderate (3), or severe (4). Total CV and CTr joint scores differed between diseases (p < .001). Male AS patients had higher CV and CTr scores than female AS patients (male CV score: 52 [range 0-96] and CTr score: 22 [range 0-80]; female CV score: 20 [range 0-96] and CTr score: 12 [range 0-79]). Strong negative correlations were detected in AS patients between chest expansion and CV (r = -0.703 p = .007) and CTr (r = -0.763 p = .002) joint involvement; positive correlations between CV and CTr joints, and modified Stoke Ankylosing Spondylitis Spinal Score (p < .05); and no significant association for MS and SC joints. CV and CTr joint involvement on thorax CT was more severe in AS and negatively affected chest expansion. The use of thorax CT scans performed for other indications in the examination of these joints may be advantageous for the early beginning of rehabilitation programs targeted at maintaining chest mobility.

Two-staged Correction for Pouter Pigeon Chest: A Less Invasive Procedure

Surgical correction of pouter pigeon chest deformity traditionally requires invasive procedures including total removal of the affected costal cartilages and major dissection of the sternum. We present a novel minimally invasive two-stage technique that was applied to an 8-year-old girl. First, the depressed lower chest was elevated using a plate with the Nuss procedure. Then, after 30 months, simultaneously with plate removal, correction of the remaining projection of the upper chest was also performed. This involved excision of only two pairs of deformed costal cartilage and a local osteotomy at the manubriosternal joint. Intraoperative blood loss was 20 mL, and the patient was discharged 7 days postoperatively. Because both the primary and secondary stages involve manual bending of the costal cartilages, our procedure may be suitably indicated only for patients in their early teenage years.

“Superior Pectus Carinatum” (Currarino–Silverman Syndrome) in a 66-year-old woman: a case report

The premature fusion of some of the sternal ossification centers and the obliteration of the manubrio-sternal joint caused a rare deformity called CurrarinoSilverman syndrome. Patients present an abnormally short sternum with a forward angulation at the manubrio-sternal junction. Cardiopulmonary diseases and spinal deformities are the most frequent related disorders. It was also described as a component of Turners and Noonans syndromes.&#x0D; Herein, we present the case of a 66-year-old woman who presented to our clinic for follow-up computed tomography after surgery and chemotherapy for breast cancer with frequent episodes of dyspnea, wheezing, bronchitis, and mild dyspnea annually, which was more frequent during childhood. Computed tomography showed the absence of metastatic lesions and other accompanying diseases, except for a rare deformity of the anterior chest wall, the so-called, a superior pectus carinatum, a chondromanubrial deformity with a dorsal-open angle of 130, and a sternum body length of 9 cm, which is not depressed in the lower third.

Evaluation of manubriosternal joint fusion and second costal cartilage calcification: Are they useful for estimating advanced age groups?

The objectives of this study were to evaluate the manubriosternal joint (MSJ) to estimate the minimum chronological age of complete fusion, and how changes in this joint influence age estimation. The study also focused on investigating the calcification patterns of the second costal cartilage (SCC), as they may be related to age. Between January and September 2020, individuals between 30 and 80years of age, who underwent chest tomography at our institution, were listed by sex and divided into five groups according to age with intervals of 10years. Twenty patients from each age group and sex were randomly selected, and 200 patients were evaluated. The relationship between age and changes in MSJ and SCC was evaluated. The incidence of complete fusion did not differ significantly between the 30 and 80 age groups. A significant difference was found between the age groups and MSJ degeneration (p < 0.001). The degree of MSJ degeneration and calcification in SCC significantly increased with age, but the range was wide. These values might be used to support traditionally accepted age-estimation methods but not as independent indicators of specific age ranges.

Whole-body magnetic resonance imaging vs. clinical evaluation of enthesitis in patients with spondyloarthritis

Whole-body magnetic resonance imaging vs. clinical evaluation of enthesitis in patients with spondyloarthritis

MANUBRIOSTERNAL JOINT SEPTIC ARTHRITIS IN A MAN WITH A HISTORY OF IV DRUG USE

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Septic arthritis is a well-documented disease, much of which contains specific guidelines and recommendations for management. Manubriosternal joint septic arthritis is a rare entity described in literature that lacks consistently successful treatment options. (1) We present the case of a patient found to have a tender chest wall mass and imaging concerns for manubriosternal septic arthritis. CASE PRESENTATION: A 47-year-old male with history of heart failure with reduced ejection fraction, drug-induced non-ischemic cardiomyopathy, cirrhosis, and history of intravenous drug use was admitted to the hospital from heart failure clinic for acute on chronic heart failure exacerbation and mild encephalopathy. He was afebrile but tachycardic with a leukocytosis (13 k/ul) upon presentation. During examination a tender, fluctuant mass was discovered over the sternum. He reported pain in this area began three weeks prior with a mass developing over the previous one week. Chest roentgenogram showed an enlarged cardiac silhouette. Follow-up chest computed tomography revealed a 5 cm x 6 cm mass containing gas surrounding the manubriosternal joint anteriorly and posteriorly. He underwent incision and drainage by cardiothoracic surgery where purulent material was found and appeared to connected to the posterior sternal fluid collection. Wound culture grew Streptococcus agalactiae. Sternal bone biopsy was negative for osteomyelitis. He was placed on IV penicillin G for four weeks of therapy. DISCUSSION: Primary manubriosternal joint infections have been rarely documented in literature with approximately 20 (adult and pediatric) cases noted in a PubMed literature search. (1) Cases appear to be more common in men approaching middle-age. Predisposing risk factors are often present and similar to those for septic arthritis of more typical joint locations including intravenous drug use, immunosuppression, and secondary sources of infection. (1,2,3) Specific treatment guidelines are not clearly defined in literature, likely due to the rarity of this disease process. (1) Various treatment methods have been reported which include various combinations of IV antibiotics, incision and drainage, and aggressive manubriosternal joint resection. (1,2,3) The most common treatment noted during the literature review was conservative management with IV antibiotics. CONCLUSIONS: Manubriosternal joint infections are infrequently seen. A majority of cases reported have presented with typical risk factors for septic arthritis. Consistent treatment guidelines are not available due to the rarity of this disease process though many are treated conservatively with IV antibiotics. Patients should be evaluated by a multidisciplinary team of cardiothoracic surgeons and infectious disease specialists for patient-centered decision making efforts. REFERENCE #1: Ali B, Shetty A, Borah G, Demas C, Schwartz JD. Successful management of sternomanubrial joint septic arthritis with pectoralis muscle flap closure: a case series. J Surg Case Rep. 2020;2020(4):rjaa035. Published 2020 Apr 29. REFERENCE #2: Peng EW, McKillop G, Prasad S, Walker WS. Septic arthritis of the manubriosternal joint. Ann Thorac Surg. 2007;83(3):1190-1194. REFERENCE #3: Carnevale A, Righi R, Maniscalco P, et al. Primary septic arthritis of the manubriosternal joint in an immunocompetent young patient: A case report. Radiol Case Rep. 2017;12(4):682-685. Published 2017 Sep 11. DISCLOSURES: No relevant relationships by Joseph Frederickson, source=Web Response No relevant relationships by Bryton Perman, source=Web Response no disclosure on file for Akshat Sood; No relevant relationships by David Wessling, source=Web Response

Sternum as an indicator for sex and age estimation using multidetector computed tomography in an Egyptian population

• Age and sex estimation techniques using the sternum were tested on an Egyptian population. • The logistic regression formula for estimating sex demonstrated 88.3% accuracy. • Fusion of the manubrio-sternal and xiphi-sternal joints were of limited use for age estimation, with binary logistic regression accuracies ranging from 63.6-75.0%. Introducing advanced radiographic techniques, like CT, in the field of forensic human identification is crucial. Sex and age are important biological attributes to be estimated during forensic identification process. The diagnostic value of sternum as an indicator for accurate sex and age estimation for an Egyptian population is still questionable. Therefore, this study aimed to evaluate the validity of sex estimation using sternal metric measurements and age estimation using fusion of manubrio-sternal joint (MSJ) and xiphi-sternal joint (XSJ) on MDCT images of a sample of Egyptian population. For sex estimation, a total of 165 MDCT images were assessed. Five sternal measurements were assessed on 88 MDCT images of known sex to develop a logistic regression equation which was then tested for its validity on 77 MDCT images of unknown sex. For age estimation, 88 MDCT images of known age were assessed for MSJ and XSJ fusion stages. Logistic regression analysis was done to denote the accuracy of estimating age (above or below 45 years) for both sex-specific and pooled-sex samples. For sex estimation, validity of logistic regression equation was as follows: sensitivity (85.7%), specificity (90.5%), and accuracy (88.3%). As regards to age, MSJ and XSJ fusions were highly variable and overall logistic regression results demonstrated low accuracy rate. We concluded that sternal measurements assessed using MDCT may represent a valid metric method for sex estimation in Egyptian population. On the other hand, MSJ and XSJ fusion stages were of limited value for age estimation.

New reduction technique simplified for surgical stabilisation of isolated manubriosternal dislocation: A case report and literature review.

Manubriosternal joint (MSJ) dislocation is often poorly tolerated, with pain, and both static and dynamic dysfunction in breathing. This injury is rare, and treatment includes both surgical and non-surgical interventions. Moreover, the treatment needs to be personalised to a specific case. We present a case of a 19-year-old Comorian man who had chest pains that were exacerbated by movements after falling from a tree. Careful physical examination revealed that the man had a 'stair step'-looking deformity located at the anterior chest wall at the level of the MSJ. A computed tomography scan confirmed the diagnosis of manubriosternal disruption. The patient underwent a surgical intervention under general anaesthesia and had an uneventful recovery.

Preventing inadvertent Endobronchial intubation: Upper incisor to manubriosternal joint length as a predictor of airway length in children.

Malpositioning of the endotracheal tube within the airway can lead to serious complications. The estimated insertion depth of the endotracheal tube should be accurate and reliable. To study whether the upper incisor-manubriosternal joint length in the extended head position can be used as a predictor of airway length to guide the depth of insertion of endotracheal tube in children and to evaluate the correlation of upper incisor-manubriosternal joint length with the upper incisor-carina length in the neutral head position, in Indian pediatric population. After induction of anesthesia, upper incisor-manubriosternal joint length was measured using a flexible metallic tape. Endotracheal tube was inserted and secured in the midline over the upper incisors. The degree of the maximum head extension was recorded with a goniometer, and the upper incisor-carina length was measured with the help of a fiberoptic bronchoscope. Analysis revealed a positive correlation between upper incisor-carina length and upper incisor-manubriosternal joint length (R=.456, R2 =.208, P=.000) and also between upper incisor-carina length and the height of the patient (R=.528, R2 =.279, P-value .000). The degree of maximum head extension did not influence the upper incisor-carina length and the upper incisor-manubriosternal joint length relationship. The upper incisor-carina length shows a positive correlation with the patient's upper incisor-manubriosternal joint length and the patient's standing height, while the degree of maximum head extension has no significant bearing on this relationship. The upper incisor-manubriosternal joint length can be used as a predictor of airway length and the depth of insertion of endotracheal tube in children.

Examining variation in skeletal tuberculosis in a late pre-contact population from the eastern mountains of Peru

Objective and materialsThis research evaluates the presence and chronology of tuberculosis (TB) in the northeastern highlands of Peru (CE 800–1535) through the analysis of osseous lesions from Pre-Contact Kuelap, Chachapoyas. MethodsWe examined macroscopic lesion morphology and distribution from the skeletal series (MNI = 207). ResultsWe determined that skeletal evidence was highly consistent with advanced multifocal and spinal tuberculosis in 13 individuals. Destructive lesions of the lower thoracic and/or lumbar vertebra bodies and sacroiliac joints are evident in most cases, but we also observed lesions within the manubriosternal, hip, and knee joints. Both adult males (n = 7) and females (n = 6) present skeletal lesions from young adult to older adults, but there is only one late adolescent. Only three individuals demonstrate similar lesion distributions. ConclusionsVariation in lesion distribution in this population-based study shows the importance of identifying extra-vertebral tuberculosis and suggests that the disease may have manifested differently than at other coastal sites. These cases confirm the presence of tuberculosis both before and after Inca occupation across this central Andean highlands region. SignificanceThis evidence for the likely endemic presence of TB in the New World prior to European Contact furthers our understanding of the distribution of this infectious disease across the region as well as elucidating lesion distribution. LimitationsThe diagnosis of tuberculosis is based on skeletal lesions and it should be confirmed by molecular analysis. Future ResearchAdditional examination of vertebral bodies (including juvenile remains) for evidence of earlier manifestations of infection.

Ultrasonographic Involvement of the anterior chest wall in Spondyloarthritis: Factors associated with 5-years structural progression. A prospective study in 58 patients.

To evaluate, factors associated with new ultrasonographic lesions of the anterior chest wall in spondyloarthritis (SpA) after a follow up of 5 years. SpA Patients included in 2013 in a first study were evaluated five years later. Ultrasound B mode and power Doppler examination of the two sternoclavicular joints and the manubrio-sternal joint were performed by the same two examinators at baseline and five years later. The presence of erosion, synovitis, ankylosis, power Doppler signal, joint effusion and joint space narrowing were assessed blind of the first evaluation. Among the 131 patients at baseline, 58 patients were evaluated 5 years later. The mean age was 48.2±11.9 years old, with 86% of male and mainly an axial disease (78%). Patient characteristics are comparable to the original cohort. The most frequent lesions were ankylosis of the manubriosternal joint (38%) and erosions of the sternoclavicular joint (29%). 31 patients (53%) developed a new lesion of the ACW. There is a statistically significant association between new lesions of the ACW and higher ASDAS CRP (1,86±1,07 VS 3,0±2,17 P<0,01) and with CRP (5,34±7,85 VS 16,2±35, P=0,035) in the moment of the examination. There was no baseline factor associated with the structural progression. The occurrence of new lesions of the anterior chest wall is associated with a higher disease activity and a higher CRP at 5 years.

Age estimation from ossification of sternum and true ribs using 3D post-mortem CT images in a Japanese population.

Age estimation of cadavers from post-mortem "chest plate" using conventional radiography, which involves radiographic assessment of ossification around the sternum and rib ends, has been evaluated without fruitful results. This study examined the value of images of the chest plate obtained by three-dimensional post-mortem CT for estimation of age at time of death in a Japanese population. Five chest plate ossification scores were evaluated in 320 subjects, including ossification of the first costal cartilage (OF), ossification of the second to seventh costal cartilages at the rib (OR) and sternal (OS) ends, fusion of the manubriosternal joint (FM), and fusion of the xiphisternal joint (FX). OS was found to have the highest correlation with age while FM had no significant correlation. The best composite score for age estimation was the summative score for both sides of the OS and the right side of the OF and FX, for which the coefficient of determination (R2) and the standard error of estimation (SEE) were 0.608 and 12.44years, respectively, for men and 0.590 and 14.65years for women. The accuracy of the model was tested in a further 26 male and 24 female subjects, and the accuracy rate within the first SEE was 57.69% and 70.83%, respectively. This rapid and non-invasive method of age estimation in the chest plate area is superior to conventional methods and could be useful for estimation of age at time of death in the Japanese population.

Manubriosternal dislocation type II associated with thoracic spine fracture: What can we learn from this?

Traumatic dislocation of the manubriosternal joint is rare, and management correction requires an individualised decision. We report a case of a young female who suffered a type II manubriosternal dislocation with concomitant thoracic spine fracture, as a result of a motor vehicle accident. The mechanism and various therapeutic outcomes are discussed, and a review of the literature provided.

Missed manubriosternal dislocation in patient with thoracolumbar fracture, a case report

BackgroundSpine fractures combined with sternal injury are most commonly occur in the thoracic region. Lower cervical and thoracolumbar injuries have also been reported, especially for the patients with manubriosternal dislocation. The type of spine injury is easily recognized in initial presentation, but we may miss the sternal fracture and manubriosternal dislocation.Case presentationA 23-year-old male patient complained with chest, right ankle, and lumbar pain after a fall at ground level, with diagnosis of right distal tibial fracture, sternal fracture, calcaneus fracture, and L2 vertebral fracture. However, neurologically he was completely normal. He underwent the operation for his lower extremity and spine, but we missed his manubriosternal dislocation after discharged. After one month, he came to the clinic with complained of chest pain, the imaging exams showed anterior dislocation of manubriosternal joint. We chose conservative treatment for manubriosternal dislocation. He was followed up at monthly intervals and radiographs along with computerized tomography showed satisfactory in fracture healing of lumber and the sternal fracture. However, the manubriosternal dislocation was malunioned. The patient had appearance deformity of the manubriosternal joint.ConclusionThis case supports the concept of the existence and clinical relevance of the thoracic cage theory, the thoracolumbar vertebrae should also be included in the thoracic cage theory.

Suppurative Arthritis of the Manubriosternal Joint.

Suppurative Arthritis of the Manubriosternal Joint.

Manubrio-sternal joint mobility during forced ventilation using non-invasive opto-electronic plethysmography: cases studies

Sternum is a flat bone composed of three parts: manubrium superiorly, xiphoid process inferiorly and the body in between (Selthofer et al. 2006). Manubrio-Sternal Joint (MSJ), also known as Louis’ ...

Sternum in ankylosing spondylitis resembling lsquo;Dagger signrsquo; in spine: A case based observation

There are several characteristic clinical and radiological features associated with ankylosing spondylitis that help in the diagnosis of this debilitating condition. The dagger sign is one of the described radiological sign resulting from fusion of contiguous spinous processes forming a dagger like appearance. Sternum, with fused manubrio-sternal or xiphisternal joints in advanced disease, can also look like a dagger that is often underappreciated. We highlight this often overlooked ‘dagger’ to be acknowledged and further evaluated as associated entity of this spondyloarthropathy.

Factors that affect the presence of the entire liver incidentally detected by the simulation computed tomography and the detection of inferior border through anthropometric measurement in breast cancer patients.

The aim was to evaluate the parameters that influence the incidental presence of whole liver detected by simulation computed tomography (simCT) while irradiation in breast cancer patients and to evaluate the factors predicting the presence of the liver in simCT scanning and defining the inferior border in simCT. We analyzed simCT radiotherapy (RT) planning images of 327 patients with breast cancer. During the evaluation, whether the entire liver was included in the simCT scanning and the level of the vertebra where the inferior border of the simCT scan passed were investigated. Left (L) and right (R) lung, L and R breast, and heart volume were recorded so that they would reflect the internal volume of the thorax. From the simCT images, anteroposterior (A-P) distance at the jugular notch level, A-P and R-L lateral distances at manubriosternal joint alignment, A-P and R-L lateral distances at xiphisternal joint alignment were measured. The predictive value of these measurements and volumes on whether the liver was present in simCT were determined by receiver operating characteristic (ROC) curve analysis. The liver was included in 72 (22%) out of 327 simCT scans. ROC analysis was applied to the whole group; bilateral lung volume (P < 0.001), bilateral lung + heart volume (P < 0.001), xiphisternal angle R-L lateral distance (P = 0.009), manubriosternal angle A-P distance (P = 0.49), R breast volume (P = 0.007), and L breast volume (P < 0.001) were associated with the visualization of liver. A total of 37 of 72 patients, whose inferior level of the simCT sections passed below L1, had entire liver visualization. The cutoff value of xiphisternal joint R-L lateral distance was found as 31.55 cm, and its sensitivity and specificity were calculated as 81%, and 60%, respectively. Through R-L lateral measurement taken from the midaxillary line at the level of the xiphisternal joint, we showed that liver would be present in simCT with a sensitivity of 81% at L1 level in those 31.55 cm and above.