OSTEOMYELITIS OF THE CLAVICLE - CLINICAL, RADIOLOGIC, AND BACTERIOLOGICAL FINDINGS IN 10 PATIENTS

Most lesions of the clavicle are traumatic and pose few diagnostic dif ficulties. Nontraumatic clavicular lesions, on the other hand, are rar e and frequently present problems in diagnosis. This report reviews th e clinical, radiologic, and bacteriologic findings in ten patients, si x of whom were diagnosed as having acute osteomyelitis and four chroni c osteomyelitis. The differential diagnosis of clavicular osteomyeliti s is also discussed. The clinical duration of the infectious process i n these patients ranged from 2 weeks to 1.5 years. All patients presen ted with pain; six had fever, three had localized swelling or a mass, and three had soft tissue abscesses. The radiographic findings also va ried: the lesion was predominantly sclerotic in four patients, lytic i n three, and mixed in two patients; in the one patient in whom magneti c resonance imaging was the only imaging study performed, these featur es could not be properly evaluated. Periosteal reaction was detected i n three patients. Staphylococcus aureus was the causal organism in fou r patients, while in the remaining six patients different microorganis ms were cultured, including Coccidioides immitis and Mycobacterium tub erculosis. Six patients required biopsy for final diagnosis. Although clavicular osteomyelitis is rare, particularly in adults, it should be considered in the differential diagnosis of a clavicular lesion. The final diagnosis often depends on the results of biopsy and cultures.