Seskute G, Kausaite D, Chalkovskaja A, Bulotaite E, Butrimiene I. Diagnostic use of superb microvascular imaging in evaluating septic arthritis of the manubriosternal joint: A case report. World J Clin Cases 2023; 11(18): 4397-4405 [PMID: 37449227 DOI: 10.12998/wjcc.v11.i18.4397]
Corresponding Author of This Article
Goda Seskute, MD, Academic Research, Doctor, Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Centre of Rheumatology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Universiteto Street 3, Vilnius 01513, Lithuania. goda.seskute@santa.lt
Research Domain of This Article
Rheumatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jun 26, 2023; 11(18): 4397-4405 Published online Jun 26, 2023. doi: 10.12998/wjcc.v11.i18.4397
Diagnostic use of superb microvascular imaging in evaluating septic arthritis of the manubriosternal joint: A case report
Goda Seskute, Dominyka Kausaite, Ana Chalkovskaja, Egle Bulotaite, Irena Butrimiene
Goda Seskute, Dominyka Kausaite, Irena Butrimiene, Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Centre of Rheumatology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
Ana Chalkovskaja, Clinic of Internal Diseases, Family Medicine and Oncology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
Egle Bulotaite, Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
Author contributions: Seskute G performed ultrasound investigations; Seskute G, Kausaite D, and Chalkovskaja A analyzed images, reviewed the literature, and wrote the original manuscript; Bulotaite E prepared and commented on magnetic resonance imaging and computed tomography views, and drafted the article; Butrimiene I was responsible for conceiving and revising the manuscript for the important intellectual content; all authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work if questions arise related to its accuracy or integrity.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Goda Seskute, MD, Academic Research, Doctor, Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Centre of Rheumatology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Universiteto Street 3, Vilnius 01513, Lithuania. goda.seskute@santa.lt
Received: March 14, 2023 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 Processing time: 104 Days and 7.3 Hours
Abstract
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 peri-synovial 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.
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.
