Published online Jun 26, 2023. doi: 10.12998/wjcc.v11.i18.4397
Peer-review started: March 14, 2023
First decision: April 19, 2023
Revised: April 28, 2023
Accepted: May 19, 2023
Article in press: May 19, 2023
Published online: June 26, 2023
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 eva
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.
Superb microvascular imaging is a useful tool for the early diagnosis of septic arthritis of the manubriosternal joint and following-up.
Core Tip: Septic arthritis is a diagnostic challenge and requires a methodical approach. The atypical course and rarity of septic arthritis of the manubriosternal joint are due to its anatomy (symphysis): The cartilaginous joint does not have a typical synovial lined capsule. Radiological imaging plays the most important role in the diagnosis. Chest X-ray and computed tomography is the least specific in the early stages. Superb microvascular imaging allows for clearer detection of synovial hypertrophy and slow flow vascularity at the early and late stages of the disease than power Doppler. Magnetic resonance imaging helps to exclude abscesses in cases with high inflammatory markers or sepsis.