Clinical Rheumatology

, 27:815 | Cite as

Imaging of the seronegative anterior chest wall (ACW) syndromes

  • Giuseppe Guglielmi
  • Giacomo Scalzo
  • Alessia Cascavilla
  • Fausto Salaffi
  • Walter Grassi
Review Article


The sternocostoclavicular (SCC) region is subject to the same diseases that occur in joints, with congenital and developmental anomalies, inflammatory and infectious diseases, soft tissue and bone tumors as well as the seronegative spondyloarthropathies, including ankylosing spondylitis, reactive arthritis, enteropathic arthritis, psoriatic arthritis, pustulosis palmoplantaris and other syndromes. Most of these conditions present with swelling of the joint, which may be associated with pain and/or tenderness. These disorders are characterised by onset usually before the age of 40 years, absence of serum autoantibodies and sometimes the association with antigen human leukocyte antigen B27. Traditional X-ray study is indicated in the initial evaluation of SCC joint disorders, but other imaging modalities typically are often necessary to clarify the pathology. Computed axial tomography scans are indicated for disease processes in which bony destruction or ossification may occur. Magnetic resonance imaging provides more detailed and useful information when evaluating suspected pathology involving inflammation or soft tissue mass. Bone scintigraphy can help to correlate active inflammation of the SCC joint with symptoms of pain. The purpose of this study is to introduce the clinical and radiological aspects of the seronegative anterior chest wall diseases, particularly the contribution of the different imaging techniques.


ACW syndromes Hyperostosis Seronegative spondyloarthropathies Sternocostoclavicular joint Synovitis 


  1. 1.
    Jeung MY, Gangi A, Gasser B, Vasilescu C, Massard G, Wihlm M, Roy C (1999) Imaging of chest wall disorders. Radiographics 19:617–637PubMedGoogle Scholar
  2. 2.
    Jurik AG (1992) Seronegative anterior chest wall syndromes. A study of the findings and course at radiography. Acta Radiol Suppl 381:1–42PubMedGoogle Scholar
  3. 3.
    Moll JM, Haslock I, Macrae IF, Wright V (1974) Associations between ankylosing spondylitis, psoriatic arthritis, Reiter’s disease, the intestinal arthropathies and Behcet’s syndrome. Medicine (Baltimore) 53:343–364CrossRefGoogle Scholar
  4. 4.
    Jurik AG (1991) Seronegative arthritides of the anterior chest wall: a follow-up study. Skelet Radiol 20:517–525CrossRefGoogle Scholar
  5. 5.
    Salaffi F, De Angelis R, Grassi W, MArche Pain Prevalence Investigation Group (MAPPING) Study (2005) Prevalence of musculoskeletal conditions in an Italian population sample: results of a regional community-based study. I. The MAPPING study. Clin Exp Rheumatol 23:819–828PubMedGoogle Scholar
  6. 6.
    El Maghraoui A, Bensabbah R, Bahiri R, Bezza A, Guedira N, Hajjaj-Hassouni N (2003) Cervical spine involvement in ankylosing spondylitis. Clin Rheumatol 22:94–98PubMedCrossRefGoogle Scholar
  7. 7.
    Kaya T, Gelal F, Gunaydin R (2006) The relationship between severity and extent of spinal involvement and spinal mobility and physical functioning in patients with ankylosing spondylitis. Clin Rheumatol 25(6):835–839PubMedCrossRefGoogle Scholar
  8. 8.
    Sieper J, Braun J, Rudwaleit M, Boonen A, Zink A (2002) Ankylosing spondylitis: an overview. Ann Rheum Dis 61:8–18Google Scholar
  9. 9.
    Hartman GH, Renaud DL, Sundaram M, Reed AM (2007) Spondyloarthropathy presenting at a young age: case report and review. Skelet Radiol 36:161–164CrossRefGoogle Scholar
  10. 10.
    Khan MA (2002) Update on spondyloarthropathies. Ann Intern Med 136:896–907PubMedGoogle Scholar
  11. 11.
    Fournié B, Boutes A, Dromer C et al (1997) Prospective study of anterior chest wall involvement in ankylosing spondylitis and psoriatic arthritis. Rev Rhum 64:22–25Google Scholar
  12. 12.
    Hradil E, Gentz CF, Matilainem T, Moeller H, Sanzen L, Uden A (1988) Skeletal involvement in pustolosis palmo-plantaris with special reference to the sterno-costo-clavicular joints. Acta Derm Venereol 68:65–70PubMedGoogle Scholar
  13. 13.
    Patterson AC, Bentley-Corbett K (1985) Pustulotic arthro-osteitis. J Rheumatol 12:611–614PubMedGoogle Scholar
  14. 14.
    Sonozaki H, Mitsui H, Miyanaga Y et al (1981) Clinical features of 53 cases with pustulotic arthro-osteitis. Ann Rheum Dis 40:547–553PubMedGoogle Scholar
  15. 15.
    Kawai K, Doita M, Tateshi H, Hirobata K (1988) Bone and joint lesions associated with pustulosis palmaris et plantaris. J Bone Jt Surg Br 70:117–122Google Scholar
  16. 16.
    Kasperczyk A, Freyschmidt J (1994) Pustulotic arthroosteitis: spectrum of bone lesions with palmoplantar pustolosis. Radioloy 191:207–212Google Scholar
  17. 17.
    Hyodoh K, Sugimoto H (2001) Pustulotic arthro-osteitis the radiologic spectrum of the disease. Semin Musculoskelet Radiol 5(2):89–93PubMedCrossRefGoogle Scholar
  18. 18.
    Tamai K, Saotome K (1999) Panclavicular ankylosis in pustulotic arthroosteitis. A case report. Clin Orthop Relat Res 359:146–150PubMedCrossRefGoogle Scholar
  19. 19.
    Ginalski JM, Landry M, Rappoport G, Chamot AM, Gerster JC (1992) MR imaging of sternocostoclavicular arthro-osteitis with palmoplantar pustulosis. Eur J Radiol 14:221–222PubMedCrossRefGoogle Scholar
  20. 20.
    Freyschmidt J, Sternberg A (1998) The bullhead sign: scintigraphic pattern of sternocostoclavicular hyperostosis and pustulotic arthroosteitis. Eur Radiol 8:807–812PubMedCrossRefGoogle Scholar
  21. 21.
    Gladman DD, Rahman P (2001) Psoriatic arthritis. In: Ruddy S, Harris ED, Sledge CB, Budd RC, Sergent JS (eds) Textbook of rheumatology. 5th edn. Saunders, Philadelphia, pp 1071–1079Google Scholar
  22. 22.
    Quarta L, Corrado A, Melillo N, Trotta A, D’onofrio F, Maruotti N, Cantatore FP (2007) Cervical myelopathy caused by periodontoid synovial pannus in a patient with psoriatic arthritis: a case report. Clin Rheumatol 26(8):1380–1382PubMedCrossRefGoogle Scholar
  23. 23.
    Gladman DD, Stafford-Brady F, Chang CH, Lewandowski K, Russell ML (1990) Longitudinal study of clinical and radiological progression in psoriatic arthritis. J Rheumatol 17:809–812PubMedGoogle Scholar
  24. 24.
    Ory PA, Gladman DD, Mease PJ (2005) Psoriatic arthritis and imaging. Ann Rheum Dis 64:55–57CrossRefGoogle Scholar
  25. 25.
    Scarpa R, Manguso F, Oriente A, Peluso R, Atteno M, Oriente P (2004) Is the involvement of the distal interphalangeal joint in psoriatic patients related to nail psoriasis? Clin Rheumatol 23:27–30PubMedCrossRefGoogle Scholar
  26. 26.
    Taccari E, Spadaro A, Riccieri V, Guerrisi R, Guerrisi V, Zoppini A (1992) Sternoclavicular joint disease in psoriatic arthritis. Ann Rheum Dis 51:372–374PubMedCrossRefGoogle Scholar
  27. 27.
    Becker NJ, Smet AA, Chathcart-Rake W, Stechschulte DJ (1986) Psoriatic arthritis affecting the manubriosternal joint. Arthritis Rheum 29:1029–1031PubMedCrossRefGoogle Scholar
  28. 28.
    Parker VS, Malhotra CM, Ho G, Kaplan SR (1984) Radiographic appearance of the sternomanubrial joint in arthritis and related conditions. Radiology 153:343–347PubMedGoogle Scholar
  29. 29.
    Aho K, Leirisalo-Repo M, Repo H (1985) Reactive arthritis. Clin Rheum Dis 11:25–40PubMedGoogle Scholar
  30. 30.
    Queiro R, Maiz O, Intxausti J, de Dios JR, Belzunegui J, González C, Figueroa M (2000) Subclinical sacroiliitis in inflammatory bowel disease: a clinical and follow-up study. Clin Rheumatol 19:445–449PubMedCrossRefGoogle Scholar
  31. 31.
    Girelli CM, Scarpellini M (2001) Gastric Crohn’s disease and SAPHO syndrome. Clin Exp Rheumatol 19:356PubMedGoogle Scholar
  32. 32.
    Yamasaki O, Iwatsuki K, Kaneko F (2003) A case of SAPHO syndrome with pyoderma gangrenosum and inflammatory bowel disease masquerading as Behcet’s disease. Adv Exp Med Biol 528:339–341PubMedGoogle Scholar
  33. 33.
    Verbruggen LA, Buyck R, Handelberg F (1985) Clavicular periosteal new bone formation in ulcerative colitis. Clin Exp Rheumatol 3:163–166PubMedGoogle Scholar
  34. 34.
    Rosner I (2002) SAPHO: disease, syndrome, or category? J Clin Rheumatol 8(1):3PubMedCrossRefGoogle Scholar
  35. 35.
    Dougados M, Van Der Linden S, Juhlin R et al (1991) The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 34:1218–1227PubMedCrossRefGoogle Scholar
  36. 36.
    Chamot AM, Benhamou CL, Kahn MF, Beraneck L, Kaplan G, Prost A (1987) Acne–pustulosis–hyperostosis–osteitis syndrome: results of a national survey—85 cases. Rev Rhum Mal Osteo-artic 54:187–196Google Scholar
  37. 37.
    Boutin RD, Resnick D (1998) The SAPHO syndrome: an evolving concept for unifying several idiopathic disorders of bone and skin. Am J Roentgenol 170:585–591Google Scholar
  38. 38.
    Ellis BI, Shier CK, Leisen JJ, Kastan DJ, McGoey JW (1987) Acne-associated spondylarthropathy: radiographic features. Radiology 162:541–545PubMedGoogle Scholar
  39. 39.
    Beretta-Piccoli BC, Sauvain MJ, Gal I et al (2000) Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome in childhood: a report of ten cases and review of the literature. Eur J Pediatr 159:594–601PubMedCrossRefGoogle Scholar
  40. 40.
    Jurik AG, Egund N (1997) MRI in chronic recurrent multifocal osteomyelitis. Skelet Radiol 26:230–238CrossRefGoogle Scholar
  41. 41.
    Hayem G, Bouchaud-Chabot A, Benali K et al (1999) SAPHO syndrome: a long term follow up study of 120 cases. Semin Arthritis Rheum 293:159–171CrossRefGoogle Scholar
  42. 42.
    Ozyemisci-Taskiran O, Bölükbasi N, Gögüs F (2007) A hidradenitis suppurativa related SAPHO case associated with features resembling spondylarthropathy and proteinuria. Clin Rheumatol 26(5):789–791PubMedCrossRefGoogle Scholar
  43. 43.
    Reith JD, Bauer TW, Schils JP (1996) Osseous manifestations of SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome. Am J Surg Pathol 20:1368–1377PubMedCrossRefGoogle Scholar
  44. 44.
    Sugimoto H, Tamura K, Fujii T (1998) The SAPHO syndrome: defining the radiologic spectrum of diseases comprising the syndrome. Eur Radiol 8:800–806PubMedCrossRefGoogle Scholar
  45. 45.
    Laiho K, Soini I, Martio J (2001) Magnetic resonance imaging findings of manubriosternal joint involvement in SAPHO syndrome. Clin Rheumatol 20:232–233PubMedCrossRefGoogle Scholar
  46. 46.
    Sonozaki H, Azuma A, Okai K et al (1979) Clinical features of 22 cases with “inter-sterno-costo-clavicular ossification”. A new rheumatic syndrome. Arch Orthop Trauma Surg 95:13–22PubMedCrossRefGoogle Scholar
  47. 47.
    Furukawa M, Miwa T, Kamide M et al (1989) Three cases of inter-sterno-costo-clavicular-ossification associated with tonsillar infection. J Laryngol Otol 103:783–786PubMedCrossRefGoogle Scholar
  48. 48.
    Colhoun EN, Hayward C, Evans KT (1987) Inter-sterno-costo-clavicular ossification. Clin Radiol 38:33–38PubMedCrossRefGoogle Scholar
  49. 49.
    Sartoris DJ, Schreiman JS, Kerr R, Resnik CS, Resnick D (1986) Sternocostoclavicular hyperostosis: a review and report of 11 cases. Radiology 158:125–128PubMedGoogle Scholar
  50. 50.
    Grigoryan M, Roemer FW, Mohr A, Genant HK (2004) Imaging in spondyloarthropathies. Curr Rheumatol Rep 6:102–109PubMedCrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2008

Authors and Affiliations

  • Giuseppe Guglielmi
    • 1
    • 2
  • Giacomo Scalzo
    • 1
  • Alessia Cascavilla
    • 1
  • Fausto Salaffi
    • 3
  • Walter Grassi
    • 3
  1. 1.Department of RadiologyUniversity of FoggiaFoggiaItaly
  2. 2.Department of RadiologyScientific Institute Hospital “CSS”FoggiaItaly
  3. 3.Department of RheumatologyUniversità Politecnica delle MarcheJesiItaly

Personalised recommendations