Sternoclavicular Joint Abscess Necessitating Empyema: Four ED Visits in Six Days

Ahmed Hashim^1, , Raai Mahmood¹, Mohamedanwar Ghandour², Hammam Shereef¹, Ammar ELJack³, Cecilia Big⁴, Kevin Jamil⁵ and Rajiv John¹

¹Department of Internal Medicine, Beaumont Health- Dearborn, MI, USA

²Division of Nephrology, Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA

³Division of Cardiology, Department of Internal Medicine, Baylor- Scott/white heart hospital, Plano, Tx, USA

⁴Division of Infectious Diseases, Department of Internal Medicine, Beaumont Health- Dearborn, MI, USA

⁵Division of Thoracic Surgery, Beaumont Health- Dearborn, MI, USA

Cite this paper

Ahmed Hashim, Raai Mahmood, Mohamedanwar Ghandour, Hammam Shereef, Ammar ELJack, Cecilia Big, Kevin Jamil and Rajiv John. Sternoclavicular Joint Abscess Necessitating Empyema: Four ED Visits in Six Days. American Journal of Medical Case Reports. 2021; 9(5):281-285. doi: 10.12691/AJMCR-9-5-5

Abstract

We report a case of Sternoclavicular Joint (SCJ) infection in a 52-year-old male who developed an empyema over six days. During the first three visits, he had worsening pectoral and shoulder pain and was symptomatically treated and discharged. During the first ED visit, a computed tomography (CT) scan of the neck was negative. During the second ED visit, CTA chest was negative for pulmonary embolism. Three days later, CTA of the neck showed density from the left first rib to the left sternoclavicular joint, suggesting a hematoma. During the final ED visit, CT of the chest showed a left anterior chest wall abscess contiguous with a left upper lobe empyema. VATS confirmed empyema and revealed costochondral and SCJ abscess. Decortication, SCJ resection, and pectoralis muscle debridement were performed. Methicillin-susceptible Staphylococcus Aureus (MSSA) was isolated from surgical cultures. After the pectoralis muscle flap closure, he was treated with IV cefazolin for a total of six weeks. Health care professionals should have a high index of suspicion for SCJ infections in patients with a similar clinical presentation. This case highlights the importance of early and prompt diagnosis of MSSA SCJ infections to prevent sequelae of the disease.

Keywords

sternoclavicular joint, video-assisted thoracoscopic surgery, decortication

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	McAninch SA, Smithson C 3rd, Juergens AL, Collins JN, Nanda A. Sternoclavicular joint infection presenting as nonspecific chest pain. J Emerg Med. 2018;54(2): 229-231.
[2]	Tanaka Y, Kato H, Shirai K, et al. Sternoclavicular joint septic arthritis with chest wall abscess in a healthy adult: a case report. J Med Case Rep. 2016; 10: 69.
[3]	Chiang C, Huang YC, Chang J-M, Chen K-H. Septic sternoclavicular arthritis, osteomyelitis and mediastinitis. Journal of Acute Medicine. 2016; 6(2): 46-48.
[4]	Ross JJ, Shamsuddin H. Sternoclavicular septic arthritis: review of 180 cases. Medicine (Baltimore). 2004; 83(3): 139-48.
[5]	Muesse JL, Blackmon SH, Ellsworth WA, Kim MP. Treatment of Sternoclavicular Joint Osteomyelitis with Debridement and Delayed Resection with Muscle Flap Coverage Improves Outcomes. Surgery Research and Practice. 2014; 2014: 747315.
[6]	Abu Arab W, Khadragui I, Echavé V, Deshaies A, Sirois C, Sirois M. Surgical management of sternoclavicular joint infection. Eur J Cardiothorac Surg. 2011 Sep; 40(3): 630-4.
[7]	Allen Murga, Hannah Copeland, Rachel Hargrove, Jason M. Wallen, Salman Zaheer. Treatment for sternoclavicular joint infections: a multi-institutional study. J Thorac Dis. 2017 Jun; 9(6): 1503-1508.