Sternocostoclavicular hyperostosis is a recently recognized disease entity of unknown cause. Although the condition bears similarities to Paget's disease, the limited and unique anatomic, clinical, and histologic findings support the hypothesis that this is a separate entity. The case reported satisfies the criteria for sternocostoclavicular hyperostosis and to our knowledge represents the first reported case to be complicated by thrombophlebitis of an upper extremity with predisposing subclavian vein obstruction.

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A 37-year-old female presented to pulmonary clinic for evaluation of exertional dyspnea and cough. Nine months before presentation she was involved in motor vehicle accident as a driver. During the accident the driver side airbag deployed and ruptured. Hours after the accident, the patient experienced airway irritation and cough. As a result of the accident, she sustained back injury that required surgical intervention. Seven months before presentation, after recovery from surgery, she noticed shortness of breath with resumption of daily activities. She was treated with antibiotics and inhaled corticosteroids without improvement. Four months before presentation, she was evaluated in an emergency department for worsening dyspnea and cough. The patient was treated empirically with short course of oral corticosteroids and Fluticasone Propionate 250 mcg/Salmeterol 50 mcg inhalation powders (Advair Diskus 250/50; GlaxoSmithKline; Research Triangle Park, NC). She noticed only transient and minimal improvement in her symptoms.She was a lifelong non-smoker and had no known occupational exposures.On physical examination vital signs were normal. The lungs were clear to auscultation. Cardiac, abdominal, and neurological exam were unremarkable. Significant drop in oxygen saturation was found after a 6 min walk test. Spirometry revealed a forced vital capacity of 1.35 l (43% predicted), a forced expiratory volume in 1 s of 1.28 l (47% predicted) and FEV1/FVC ratio of 94% that is compatible with severe restrictive lung disease. A computed tomography (CT) of the chest was performed (Fig. 1) that revealed patchy bilateral ground-glass infiltrates and consolidations. These findings suggest interstitial and alveolar inflammation.Dry cough, dyspnea on exertion, restrictive physiology, and diffuse ground-glass infiltrates on CT scan is characteristic of interstitial lung disease (ILD). A lung biopsy was obtained by video-assisted thoracoscopy surgery (VATS) (Fig. 2). Pathologic examination of lung biopsy showed nonspecific interstitial pneumonitis (NSIP) pattern. Differential diagnosis of NSIP pattern includes: pneumonitis secondary to autoimmune disorders, inhalationinduced lung injury, drug reactions, and hypersensitivity pneumonitis. Detailed history, physical Injury Extra (2006) 37, 181-183 www.elsevier.com/locate/inext * Corresponding author. Tel.: +1 215 955 6591; fax: +1 215 955 0830.