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Ultrasound-guided intra-articular corticosteroid injection in a patient with manubriosternal joint involvement of ankylosing spondylitis:A case report

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World Journal of Clinical Cases 2023年第9期11卷 2043-2050页

作者： Min-Hee Choi In-Young Yoon Won-Joong Kim Department of Anesthesiology and Pain Medicine Ewha Womans University Mokdong HospitalSeoul 07985South Korea

BACKGROUND manubriosternal joint(MSJ)disease is a rare cause of anterior chest pain but can be a major sign of systemic arthritic involvement.In patients with ankylosing spondylitis(AS),a type of systemic arthritis,chest pain can be due to MSJ involvement and can be improved by ultrasound-guided corticosteroid injection into the joint.CASE SUMMARY A 64-year-old man visited our pain clinic complaining of anterior chest pain.There were no abnormal findings on lateral sternum X-ray,but arthritic changes in the MSJ were observed on single-photon emission computed tomography-computed tomography.We performed additional laboratory tests,and he was finally diagnosed with AS.For pain relief,we performed ultrasound-guided intra-articular(IA)corticosteroid injections into the MSJ.After the injections,his pain nearly resolved.CONCLUSION For patients complaining of anterior chest pain,AS should be considered,and single-photon emission computed tomography-computed tomography can be helpful in diagnosis.In addition,ultrasound-guided IA corticosteroid injections may be effective for pain relief.

关键词： Ankylosing spondylitis Anterior chest pain manubriosternal joint Single-photon emission computed tomography-computed tomography Case report

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Diagnostic use of superb microvascular imaging in evaluating septic arthritis of the manubriosternal joint:A case report

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World Journal of Clinical Cases 2023年第18期11卷 4397-4405页

作者： Goda Seskute Dominyka Kausaite Ana Chalkovskaja Egle Bulotaite Irena Butrimiene Clinic of Rheumatology Orthopaedics Traumatologyand Reconstructive SurgeryCentre of RheumatologyInstitute of Clinical MedicineFaculty of MedicineVilnius UniversityVilnius 01513Lithuania Clinic of Internal Diseases Family Medicine and OncologyInstitute of Clinical MedicineFaculty of MedicineVilnius UniversityVilnius 01513Lithuania Department of Radiology Nuclear Medicine and Medical PhysicsInstitute of Biomedical SciencesFaculty of MedicineVilnius UniversityVilnius 01513Lithuania

BACKGROUND Septic arthritis of the manubriosternal joint is a diagnostic challenge due to its rarity and anatomical characteristic.Conventional ultrasound,plain radiographs,and computed tomography are not able to confirm or even suspect arthritis early.Superb microvascular imaging is a new advanced Doppler technique in evaluating low-flow microvascular patterns.The higher sensitivity for increased perisynovial vascularity helps to suspect septic arthritis and forms a methodical approach to using magnetic resonance imaging(MRI).CASE SUMMARY A 34-year-old immunocompetent woman presented with a fever and a dull ache in the chest radiating to the right arm.Traumatic injury and the most common respiratory and cardiac disorders were ruled out.Blood cultures came back positive for Staphylococcus aureus,and sepsis was confirmed.A small lump was noted on the chest during the first week of hospitalization.Superb microvascular imaging was performed and septic arthritis of the manubriosternal joint was detected.MRI confirmed the diagnosis and showed septic arthritis of the manubriosternal joint with several localized abscesses behind the sternum.The patient was treated for three weeks with intravenous antibiotics and the outcome was favorable:Inflammatory markers became normal,and the lump disappeared.Three months later,the patient was examined for a new episode of mild pain in the sternum and was diagnosed with persistent perichondritis by ultrasound in comparison with MRI.CONCLUSION Superb microvascular imaging is a useful tool for the early diagnosis of septic arthritis of the manubriosternal joint and following-up.

关键词： Power Doppler Superb microvascular imaging Ultrasound Septic arthritis manubriosternal joint Case report

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