THE BULLHORN-SIGN-SCINTIGRAPHIC PATTERN O F STERNOCOSTOCLAVICULAR HYPEROSTOSIS AND PUSTULOTIC ARTHROOSTEITIS

27 patients with sternocostoclavicular hyperostosis (SCC) and/or pustu lotic arthroosteitis (PAO) were examined with whole body scintigraphy, conventional radiography, and other imaging modalities, such as CT, M RI. 25 of 27 patients with SCCH showed st characteristic high bullhorn -like uptake of the sternocostoclavicular region with the manubrium st eni representing the skull and the inflamed sternocostoclavicular join ts corresponding to the hems (=bullhorn-sign). Scintigraphy revealed a dditional skeletal manifestations (spondylitis, sacroiliitis, osteitis , periostitis) in 19 of the 27 patients with SCCH and/or PAO. In combi nation with PPP or psoriasis pustulosa, the typical scintigraphic bull horn pattern enables the diagnosis of PAO (19 patients) with high conf idence. Patients with SCCH but without skin disease at the time of pre sentation (8 of 27 patients) may develop PPP later and, therefore, it is justified to classify them as incomplete PAO with high risk to deve lop other skeletal manifestations later in the course of the disease.