Wednesday, November 7, 2018

Rare Synostositis in Ankylosing Spondylitis

Today, one of our patients with ankylosing spondylitis visited us. He described a swelling of the sternum, which had developed during the last four days. I palpated a swelling in the upper part of the sternum, where manubrium sterni (handle) and corpus sterni (body) meet, right in the middle. Therefore, an inflammation of a costo-sternal joint could already be excluded.
A bony change was not to be expected, but could also be excluded by the X-ray of the lateral thorax, which was made for another reason.
The ultrasound examination revealed a roundish elevation above the manubriosternal symphysis of about 4 mm in diameter. Neo-vasculization could be shown in the color coded Doppler examination
In summary, the swelling is a symphysitis manubriosternalis. This is a rare manifestation in patients with ankylosing spondylitis.

If one looks long enough at the manubriosternal symphysis, one may get the idea of a soft tissue swelling ...

The ultrasound picture, however, shows a swelling

The color coded Doppler in B/W print-out 
shows neo-vasculization

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