title: Sternocostoclavicular Hyperostosis: An Ill-Recognized Disease.
abstract: Sternocostoclavicular hyperostosis (SCCH) is an ill-recognized, rarely diagnosed disease. Today, SCCH is widely considered part of the synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome. SCCH develops over years with intermittent attacks of pain, swelling, and reddening of the sternocostoclavicular region. The disease causes progressive hyperostosis, fusion of the sternocostoclavicular joints, and soft tissue ossification. SCCH is chronic, non-malignant, and occurs predominantly bilaterally in middle-aged women. The incidence of the disease is unknown. We present a case of isolated SCCH, where chest radiographs showed a clear development of bilateral disease over the course of more than a decade. Whole-body bone scintigraphy was performed and was suggestive of SCCH. The diagnosis was established as late as 14 years from the onset of symptoms. During this period, the patient underwent several inconclusive examinations, resulting in a delay of diagnosis and in prolonged and aggravated symptoms. With this case report, we want to draw attention to SCCH and the importance of early diagnosis of the disease.
authors.affiliation: Department of Diagnostic Imaging, Nordsjællands Hospital Hillerød, Copenhagen University Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark. bolette@boletteroed.com.|Department of Radiology, Rigshospitalet, Copenhagen University Hospital Copenhagen, Blegdamsvej 9, 2100 København Ø, Denmark. bolette@boletteroed.com.
authors.forename: Bolette
authors.initials: B
authors.lastname: Roed
authors.affiliation: Department of Diagnostic Imaging, Nordsjællands Hospital Hillerød, Copenhagen University Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark. tatiana.kristensen.01@regionh.dk.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Kristensen
authors.affiliation: Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital Hillerød, Copenhagen University Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark. soeren.thorsen@regionh.dk.
authors.forename: Søren
authors.initials: S
authors.lastname: Thorsen
authors.affiliation: Department of Diagnostic Imaging, Nordsjællands Hospital Hillerød, Copenhagen University Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark. klaus.poulsen.bloch@regionh.dk.
authors.forename: Klaus
authors.initials: K
authors.lastname: Poulsen Bloch
authors.affiliation: Department of Diagnostic Imaging, Nordsjællands Hospital Hillerød, Copenhagen University Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark. pia.maria.tullia.afzelius@regionh.dk.
authors.forename: Pia
authors.initials: P
authors.lastname: Afzelius
keywords: SAPHO syndrome; SCCH; bullhead sign; shoulder girdle; sternocostoclavicular hyperostosis; sternocostoclavicular joint; technetium-99m diphosphonate