Imaging Appearances of the Sternum and Sternoclavicular Joints

Abstract

The sternum and sternoclavicular joints--critical structures of the anterior chest wall--may be affected by various anatomic anomalies and pathologic processes, some of which require treatment. Pectus excavatum and pectus carinatum are common congenital anomalies that are usually benign but may warrant surgical treatment if they cause compression of vital internal structures. By contrast, developmental variants such as the sternal foramen are asymptomatic and do not require further evaluation or treatment. Arthritides of the sternoclavicular joint (osteoarthritis, septic arthritis, and seronegative arthropathies) are common and must be differentiated before an appropriate management method can be selected. The recognition of complications of sternotomy (eg, sternal dehiscence, secondary osteomyelitis) is critical to avoid life-threatening sequelae such as acute mediastinitis. Likewise, the detection of sternal fractures and sternoclavicular dislocations is important, especially where they impinge on vital structures. In addition, sternal malignancies (most commonly, metastases and chondrosarcoma) must be distinguished from benign neoplasms. To achieve accurate and timely diagnoses that facilitate appropriate treatment, radiologists must be familiar with the appearances of these normal anatomic variants and diseases of the sternum.

Evaluation of postnatal development and variations of sternum using multi-detector computed tomography

“…The accessory bone, known as the suprasternal bone or the episternal bone, is observed in the upper and posterior part of the manubrium in 1.5% of cases in the population (2). The suprasternal bone was observed in five of our cases (three cases were bilateral and two cases were unilateral).…”

“…The sternum consists of the following three parts: the manubrium, the body, and the xiphoid process (XP) (1,2). The sternum develops over a long period of time, which begins during the prenatal period and continues through the third and fourth decades of the postnatal period (3)(4)(5)(6).…”

Solitary Plasmacytoma of the Sternum Detected Incidentally by MR Imaging of the Cervical Spine

“…2 In a series of 11,087 Dahlin bone tumors at the Mayo Clinic, 8 Restrepo 2 reported only 66 (0.6z) primary malignant tumors of the sternum, which included 22 (33 z) chondrosarcomas and 20 (30z) myelomas that included plasmacytomas.…”

“…[4][5][6][7] On MR imaging, lesions usually appear as intermedullary zones with low intermediate signal on T 1 -weighted images (T 1 WI), from slightly high to high signal on T 2 -weighted images (T 2 WI), and with high signal on fat suppression T 2 WI or STIR. [1][2][3] Metastatic disease is the most common diŠeren-tial diagnosis, 1,8,10 and non-Hodgkin lymphoma, Langerhans histiocytosis, and osteomyelitis are possibilities. 1 In our case, negative bone scintigraphy suggested a low possibility of metastatic disease.…”

“…[1][2][3] Several cases aŠecting the sternum have been reported. [4][5][6][7] However, to the best of our knowledge, in most of these, the tumor broke through the cortex of the sternum and spread into adjacent soft tissue of the anterior chest wall, and patients then complained of pain of the anterior chest wall.…”