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.
© RSNA, 2009
References
- 1
, Teplick SK, Kay H. Computed tomography of the normal sternum. AJR Am J Roentgenol1983; 141: 219–223.Goodman LR - 2
, Williams PL, Bannister LH. Gray’s anatomy: the anatomical basis of medicine and surgery. New York, NY: Churchill Livingstone, 1995.Gray H - 3
, Jaramillo D. CT of the sternum. AJR Am J Roentgenol1986; 147: 72–77.Stark P - 4
, Gilula LA, Murphy WA, Sagel SS. Computed tomography of the sternoclavicular joint and sternum. Radiology1981; 138: 123–128.Destouet JM - 5
, Berland LL, Ho KJ. Computed tomography evaluation of primary and secondary sternal neoplasms. J Comput Tomogr1986; 10: 27–32.Shin MS - 6
. Computed tomography of the sternum. Crit Rev Diagn Imaging1987; 27: 321–349.Stark P - 7
. Imaging of the newborn, infant, and young child. Baltimore, Md: Williams & Wilkins, 1997.Swischuk LE - 8
, Donnelly LF, Brody AS, Anton CG, Poe SA. “Missing” sternal ossification center: potential mimicker of disease in young children. Radiology2002; 224: 120–123.Rush WJ - 9
, Gross BH, Glazer GM, Martel W. Computed tomography of the sternum and its articulations. Skeletal Radiol1984; 11: 197–203.Hatfield MK - 10
, Tunaci M, Tunaci A, Dursun M, Acunas G. Frequency of sternal variations and anomalies evaluated by MDCT. AJR Am J Roentgenol2006; 186: 956–960.Yekeler E - 11
, Rajesh A, Entwisle J, Jeyapalan K. Pictorial review: MRI of the sternum and sternoclavicular joints. Br J Radiol2002; 75: 627–634.Aslam M - 12
, Stabler A, Preidler KW, Trudell D, Resnick D. Sternoclavicular joint: MR imaging–anatomic correlation. Radiology1996; 198: 193–198.Brossmann J - 13
, Miro PA, Spreitzer AM, Carrera GF. MR imaging of the normal sternoclavicular joint: spectrum of findings. AJR Am J Roentgenol1995; 165: 391–393.Klein MA - 14
, Stacey MW, Kelly RE Jr, et al. Family study of the inheritance of pectus excavatum. J Pediatr Surg2006; 41: 1699–1703.Creswick HA - 15
, Gangi A, Gasser B, et al. Imaging of chest wall disorders. RadioGraphics1999; 19: 617–637.Jeung MY - 16
, Crabbe DC. Pectus deformities of the anterior chest wall. Paediatr Respir Rev2003; 4: 237–242.Williams AM - 17
, Kelly RE Jr, Croitoru D, Nuss D. Chest wall anomalies: pectus excavatum and pectus carinatum. Adolesc Med Clin2004; 15: 455–471.Goretsky MJ - 18
, Welch KJ, Castaneda AR, Keane JF, Fyler DC. Anterior chest wall deformities and congenital heart disease. J Thorac Cardiovasc Surg1988; 96: 427–432.Shamberger RC - 19
, Haller JA Jr, Jelus KL, Loughlin GM, Marcus CL. Cardiorespiratory function before and after corrective surgery in pectus excavatum. J Pediatr1996; 128: 638–643.Quigley PM - 20
, Welch KJ. Cardiopulmonary function in pectus excavatum. Surg Gynecol Obstet1988; 166: 383–391.Shamberger RC - 21
Jr, Kramer SS, Lietman SA. Use of CT scans in selection of patients for pectus excavatum surgery: a preliminary report. J Pediatr Surg1987; 22: 904–906.Haller JA - 22
, Nakahira M, Takeuchi S, et al. Indications for surgical treatment of funnel chest by chest radiograph. Pediatr Surg Int2001; 17: 591–595.Ohno K - 23
, Welch K, Micheli LJ, Shamberger R, Hall JE. Scoliosis in children with pectus excavatum and pectus carinatum. J Pediatr Orthop1989; 9: 551–556.Waters P - 24
. Congenital chest wall deformities. In: O’Neill J, Rowe MI, Grosfeld JL, et al, eds. Pediatric surgery. 5th ed. St. Louis, Mo: Mosby, 1998; 787–817.Shamberger, RC - 25
, Beanes S. Surgical management of pectus carinatum: 30 years’ experience. World J Surg2001; 25: 898–903.Fonkalsrud EW - 26
, Frush DP, Foss JN, O’Hara SM, Bisset GS 3rd. Anterior chest wall: frequency of anatomic variations in children. Radiology1999; 212: 837–840.Donnelly LF - 27
, Taylor CN, Emery KH, Brody AS. Asymptomatic, palpable, anterior chest wall lesions in children: is cross-sectional imaging necessary? Radiology1997; 202: 829–831.Donnelly LF - 28
, Khandelwal NK, Venkatramu NK, Chari PS. Congenital sternal cleft. Br J Plast Surg2001; 54: 259–261.Biswas G - 29
. Cleft sternum and sternal foramen. Chest Surg Clin N Am2000; 10: 261–276.Fokin AA - 30
, Robinson M, Gibbons P, Parikh DH. Cleft sternum: case report and literature review. Pediatr Pulmonol2004; 37: 375–377.Abel RM - 31
, Watkins GE, Hildebrandt-Stark HE, Dunbar RD. Episternal ossicles. Radiology1987; 165: 143–144.Stark P - 32
, Spreitzer AM, Miro PA, Carrera GF. MR imaging of the abnormal sternoclavicular joint: a pictorial essay. Clin Imaging1997; 21: 138–143.Klein MA - 33
, Kuhn JE. Atraumatic disorders of the sternoclavicular joint. J Am Acad Orthop Surg2005; 13: 138–145.Higginbotham TO - 34
, Duvey A, Da Silva F, et al. Computed tomography of sternoclavicular joint lesions in spondylarthropathies. Skeletal Radiol1997; 26: 419–423.Louvel JP - 35
, Malhotra CM, Ho G Jr, Kaplan SR. Radiographic appearance of the sternomanubrial joint in arthritis and related conditions. Radiology1984; 153: 343–347.Parker VS - 36
, O’Connor PJ, Grainger AJ. Advanced imaging in rheumatoid arthritis. I. Synovitis. Skeletal Radiol2007; 36: 269–279.Farrant JM - 37
. Seronegative arthritides of the anterior chest wall: a follow-up study. Skeletal Radiol1991; 20: 517–525.Jurik AG - 38
, Pfirrmann CW, Kissling RO, Hodler J, Zanetti M. Whole body MR imaging in ankylosing spondylitis: a descriptive pilot study in patients with suspected early and active confirmed ankylosing spondylitis. BMC Musculoskelet Disord2007; 8: 20.Weber U - 39
, Pope TL Jr. Gout: a clinical and radiologic review. Radiol Clin North Am2004; 42: 169–184.Monu JU - 40
, Resnick D. Calcium pyrophosphate dihydrate crystal deposition disease revisited. Radiology1996; 200: 1–9.Steinbach LS - 41
, Boutin RD, Vaughan LM, Haghighi P, Resnick D. Tophaceous pseudogout of the sternoclavicular joint. AJR Am J Roentgenol1999; 172: 1587–1589.Richman KM - 42
, Cotten A. SAPHO: syndrome or concept?—imaging findings. Skeletal Radiol2003; 32: 311–327.Earwaker JW - 43
Jr, Stevens DL. Primary sternal osteomyelitis. West J Med1989; 151: 199–203.Gill EA - 44
, Jurik AG. Sternal osteomyelitis in drug addicts. J Bone Joint Surg Br1990; 72: 328–329.Boll KL - 45
. Primary sternal osteomyelitis in children with sickle cell disease. Pediatr Infect Dis J1999; 18: 940–942.Narchi H - 46
, Keil A, Thonell S, Orford J, Burgner D. Primary sternal osteomyelitis: a case series and review of the literature. J Pediatr Surg2005; 40: 1623–1627.Upadhyaya M - 47
, Patkar D, Parikh B, et al. Tuberculosis of the sternum and clavicle: imaging findings in 15 patients. Skeletal Radiol2000; 29: 447–453.Shah J - 48
, Martin-Hervas C, Gil-Garay E. Primary sternal osteomyelitis caused by Actinomyces israelii. South Med J2006; 99: 96–97.Pinilla I - 49
, Gimenez A, Alegret X, Sanchis E, Rivas A. Imaging findings of sternal abnormalities. Eur Radiol1997; 7: 492–497.Franquet T - 50
, Oztekin PS, Ozdemir N, Sak SD, Erden I, Akyar S. CT and MRI in tuberculous sternal osteomyelitis: a case report. Clin Imaging2002; 26: 112–115.Atasoy C - 51
, Aguado JM, Cortina J, et al. Infection of sternal wound in heart surgery: analysis of 1000 operations [in Spanish]. Med Clin (Barc)1996; 106: 401–404.Cobo J - 52
, Habib RH. Factors predisposing to median sternotomy complications: deep vs superficial infection. Chest1996; 110: 1173–1178.Zacharias A - 53
, Fishman EK. CT evaluation of poststernotomy complications. AJR Am J Roentgenol1992; 159: 45–50.Templeton PA - 54
, Fishman EK. Evaluations of complications after sternotomy using single- and multidetector CT with three-dimensional volume rendering. AJR Am J Roentgenol2003; 181: 1065–1070.Li AE - 55
, Fiore V, D’Agostini A, et al. Sternal wound infection revisited. Eur J Nucl Med2000; 27: 660–667.Liberatore M - 56
, Salai M, Sidi Y, Gur H. Sternoclavicular infectious arthritis in previously healthy adults. Semin Arthritis Rheum2002; 32: 189–195.Bar-Natan M - 57
, Shamsuddin H. Sternoclavicular septic arthritis: review of 180 cases. Medicine (Baltimore)2004; 83: 139–148.Ross JJ - 58
, Ortenwall P, Wikstrom T. Cardiovascular injuries associated with sternal fractures. Eur J Surg2001; 167: 243–248.Rashid MA - 59
, Ince A, Junge A, Schnabel M, Bahrs C. The sternal fracture: radiographic analysis of 200 fractures with special reference to concomitant injuries. J Trauma2004; 57: 837–844.von Garrel T - 60
, Roszler MH. CT findings of sternal fracture. Injury1998; 29: 623–626.Huggett JM - 61
, Nachtigal A, Scharf Y. Spontaneous fracture of the sternum simulating myocardial infarction. Clin Rheumatol1995; 14: 478–480.Schapira D - 62
, Gay SB. CT of blunt chest trauma. AJR Am J Roentgenol1990; 154: 55–60.Kerns SR - 63
, Kanne JP, Stern EJ. Spectrum of blunt chest injuries. J Thorac Imaging2005; 20: 89–97.Thoongsuwan N - 64
, Ghysen D. Post-traumatic posterior sternoclavicular dislocation: case report and review of the literature. Emerg Radiol2002; 9: 323–325.Salgado RA - 65
, Frangen TM, Muller EJ, Muhr G, Hopf F. Traumatic manubriosternal dislocation. Arch Orthop Trauma Surg2006; 126: 411–416.Kalicke T - 66
, Kay HR, Teplick SK, Mundth ED. Complications of median sternotomy: computed tomographic evaluation. AJR Am J Roentgenol1983; 141: 225–230.Goodman LR - 67
, Cederlund K, Aberg B, Vaage J. Computed tomography of the sternum and mediastinum after median sternotomy. Ann Thorac Surg1999; 68: 858–863.Bitkover CY - 68
, Gill H, Granfeldt H, Ahlfeldt H, Rutberg H. Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg2001; 20: 1168–1175.Ridderstolpe L - 69
, Mansilla AV, White CS, Fisher MS. Sternal dehiscence in patients with and without mediastinitis. J Thorac Imaging2001; 16: 106–110.Boiselle PM - 70
, Mansilla AV, Fisher MS, McLoud TC. Wandering wires: frequency of sternal wire abnormalities in patients with sternal dehiscence. AJR Am J Roentgenol1999; 173: 777–780.Boiselle PM - 71
, Mansilla AV. A closer look at the midsternal stripe sign. AJR Am J Roentgenol2002; 178: 945–948.Boiselle PM - 72
, Nava M, Lequaglie C, Ravasi G, Pastorino U. Sternal resection for primary or secondary tumors. J Thorac Cardiovasc Surg1997; 114: 93–99.Incarbone M - 73
, Huvos AG, Martini N. Primary and secondary malignancies of the sternum. Semin Thorac Cardiovasc Surg1999; 11: 293–296.Downey RJ - 74
, O’Dwyer H, Flint J, Munk PL, Muller NL. Malignant chest wall neoplasms of bone and cartilage: a pictorial review of CT and MR findings. Br J Radiol2007; 80: 678–684.O’Sullivan P - 75
. Dahlin’s bone tumors: general aspects and data on 11,087 cases. Philadelphia, Pa: Lippincott-Raven, 1996.Unni KK - 76
, Huvos AG, Burt ME, et al. Predictors of survival in malignant tumors of the sternum. J Thorac Cardiovasc Surg1996; 111: 96–105; discussion 105–106.Martini N - 77
, Stines J, Schwab MP, et al. Les tumeurs primitives du sternum. Rev Im Med1994; 6: 681–685.Hoeffel JC - 78
Jr, Lucas GL, McFarland GB Jr. Tumors of the thoracic skeleton: review of 134 cases. J Thorac Cardiovasc Surg1966; 52: 311–321.Ochsner A - 79
, Gladish GW, Kusumoto M, et al. Chest wall tumors: radiologic findings and pathologic correlation. II. Malignant tumors. RadioGraphics2003; 23: 1491–1508.Tateishi U - 80
, Moser RP Jr, Kransdorf MJ. Chondrosarcoma of the sternum: CT features. J Comput Assist Tomogr1989; 13: 806–810.Aoki J - 81
, Umer MA, Bernardy MO. Solitary plasmacytoma of the sternum: diagnosis by computed tomography. J Comput Tomogr1985; 9: 17–19.Woodring JH - 82
, Meuzelaar KJ, van der Lei B, Pras B, Hoekstra HJ. Osteosarcoma of the sternum. Eur J Surg Oncol1997; 23: 90–91.Douglas YL - 83
. Primary malignant tumors of the chest wall: the Memorial Sloan-Kettering Cancer Center experience. Chest Surg Clin N Am1994; 4: 137–154.Burt M - 84
, Sabloff BM, Munden RF, Truong MT, Erasmus JJ, Chasen MH. Primary thoracic sarcomas. RadioGraphics2002; 22: 621–637.Gladish GW - 85
, Azouz EM, Jain KA. Large intrathoracic tumors in children: imaging findings. AJR Am J Roentgenol1995; 165: 925–934.Ablin DS - 86
, Meese EH, D’Amato NA, Maughon JS. Localized Hodgkin’s disease presenting as a sternal tumor and treated by total sternectomy. Ann Thorac Surg1966; 2: 87–93.Arnold HS - 87
, Pernot C, Juncker P. Radiologic patterns of the sternum in Noonan’s syndrome with congenital heart defect. Am J Dis Child1981; 135: 1044–1046.Hoeffel JC - 88
, Hoeffel JC. Imaging findings of sternal abnormalities. Eur Radiol1998; 8: 668–669.Hoeffel C