Table 2.
Cases of sternoclavicular joint tuberculosis reported in world literature.
| Author,Year, Language, number of SCJ TB patients | Presentation | Radiology | Biopsy/FNAC | TB-PCR | Treatment | Follow-up | Outcome | Comment/Co-morbidities |
|---|---|---|---|---|---|---|---|---|
| Simon GL, Worthington MG5 1982 English 1 patient |
46/M Soft tissue mass adherent to the medial aspect of the left clavicle for 3 months |
Xray- defect at the medial end of the left clavicle; CT- defect involving the medial clavicle and SCJ with diffuse sclerosis of the adjoining bone |
Necrotic material with caseating granuloma; AFB+; culture + | NA | Isoniazid and Ethambutol | Lost to follow-up | Not known | Past history of alcoholic hepatitis, TB epididymitis |
| Martini M6 (out of 74 cases of TB, one was SCJ TB) 1986 English 1 patient |
Lt SCJ involvement | NA | NA | NA | NA | NA | NA | NA |
| Bezza et al.2 1998 English 2 patients |
38/M Swelling |
Erosion on CT | Histopathology + | NA | 6 months ATT | 8 months | Favourable | |
| 46/F Swelling |
Erosion on CT | Histopathology + | NA | 9 months ATT | 6 months | Favourable | ||
| Yasuda et al.7 1995 English 3 patients |
71/M Painless swelling Rt SCJ for 9 months |
Xray- lytic lesion clavicle; CT and MRI- soft tissue mass; Gallium scan-abnormal isotope accumulation |
Open biopsy showed MTB | 2 year | Pulmonary TB | |||
| 54/M Painless swelling Rt SCJ for 9 months |
Xray- erosion clavicle and first rib; Arthogram- communication between lung and SCJ |
ATT with debridement with excision of Clavicle, rib, sterum | 3 years | Pulmonary TB | ||||
| Painless swelling Lt SCJ with discharging sinus, decreased shoulder movement | Xray- partial destruction clavicle and sternum; CT- soft tissue swelling and erosion clavicle; Tc99- abnormal uptake Fistulogram- track to SCJ |
Fistula excision; clavicle resection and medical debridement |
2 year | Pulmonary TB | ||||
| Fang et al.8 1997 English 1 patient |
34/F painless mass Lt SCJ 3 months | Xray chest- resorption of proximal clavicle; CT- heterogeneous enhanced tumor with erosion of clavicle and sternum; Bone scan- a focal area of increased uptake |
Biopsy- caseating grauloma | – | Total resection of mass with ATT |
NA | NA | On hemodialysis, anaemic |
| Shah J3 2000 English 8 patients |
36/F Lt SCJ Swelling, fever |
Xray- Normal; MRI- destruction with signal intensity in clavicle and soft tissue mass |
Biopsy confirmed TB | NA | NA | NA | NA | |
| 28/F Rt SCJ Painless swelling, fever |
Xray- articular erosion clavicle; MRI- destruction with signal intensity in clavicle and soft tissue mass |
Sputum for AFB +; Biopsy + | NA | NA | NA | NA | Pulmonary TB | |
| 78/M Rt SCJ Painful swelling, fever |
Xray- articular erosion clavicle; MRI and CT- destruction with signal intensity over clavicle and soft tissue mass |
Culture for MTB +; Biopsy + | NA | NA | NA | NA | Diabetic hypertensive | |
| 60/M Lt SCJ Painful swelling, fever |
Xray- articular destruction of clavicle; MRI- signal intensity of clavicle and sternum, soft tissue mass |
sputum AFB+; Culture for MTB +; Biopsy + |
NA | NA | NA | NA | Diabetic; H/O Pulmonary TB | |
| 62/M Lt SCJ Painless swelling, fever |
Xray- normal CT- soft tissue mass extension |
Histopathology + | NA | NA | NA | NA | Cirrhosis of liver, TB of wrist and L2 vertebra | |
| 66/M Lt SCJ Painless swelling, fever, |
CT- SCJ, clavicular destruction, normal sternum, large extrapleural abscess |
Culture for MTB +; Biopsy + | NA | NA | NA | NA | ||
| 53/M Rt SCJ Painful swelling, fever |
Xray- normal; CT- Rt SCJ, clavicular, manubrium and body of sternum (ant. and post. cortex) destruction, soft tissue mass extension |
Culture for MTB +; Biopsy + | NA | NA | NA | NA | Gall bladder calculi; HIV+; Pulmonary and mediastinal TB | |
| 58/F Rt SCJ Painful swelling |
CT- Rt SCJ shows increased joint space, minimal sternal destruction, soft tissue mass extension | Culture for MTB +; Biopsy + | NA | NA | NA | NA | ||
| Sy et al.9 2000 French 1 patient |
Painless swelling, 4 months | Xray- Increased joint space with lytic lesion of sternum | Aspiration- AFB+ | 9 month healing, died after 2 month (unrelated cause) | HIV + | |||
| Dhillon et al.10 2000 English 1 patient |
28/M Painful either side, 3 months | Xray- normal; CT- destruction of sternum, clavicle and first rib | Rt side open biopsy- grauloma | NA | 16 months ATT | NA | Healed | |
| Fukasawa et al.11 2001 English 1 patient |
Lt SCJ Painless mass, 10 months |
CT- heterogenously enhanced mass lesion, which expanded over the Lt SCJ and the surrounding soft tissues |
FNAC -granulomatous; Culture + |
1 year; symptoms improved | Malignancy or metastatic tumor; diabetes mellitus; hemodialysis; no response to antibiotics | |||
| Dhillon et al.12 2001 English 8 cases |
28/M Bilateral pain and swelling |
Xray- normal | FNAC/Biopsy- granulomatous pathology | NA | 18months ATT | 48 months | Healed | |
| 18/M Lt Pain and swelling for 9 months |
Xray- cystic lesion | FNAC/Biopsy- granulomatous pathology | NA | 16 months ATT | 90 months | Healed | ||
| 41/M Rt, Painful swelling with constitutional symptoms for 11 months |
Xray- normal | FNAC/Biopsy- granulomatous pathology | NA | 15 months ATT | 78 months | Healed | ||
| 29/F Rt Discharging sinus, 10 months |
Xray- normal | FNAC/Biopsy- granulomatous pathology | NA | 16 months ATT | 72 months | Healed | ||
| 39/M 32 month, Rt Pain and swelling |
Xray- normal | FNAC/Biopsy- granulomatous pathology | NA | 16 months ATT | 50 months | Healed | ||
| 50/F 8 month, Lt Swelling |
Xray- normal | FNAC/Biopsy- granulomatous pathology | NA | 14 months ATT | 35 months | Healed | ||
| 37/M 12 month, Lt Pain and swelling |
Xray- normal | FNAC/Biopsy- granulomatous pathology | NA | 15 months ATT | 28 months | Healed | ||
| 22/M 14 month, Rt Swelling |
Xray- normal | FNAC/Biopsy- granulomatous pathology | NA | 16 months ATT | 64 months | Healed | ||
| 34/M 12 month, Rt Pain and swelling |
Xray- normal | FNAC/Biopsy- granulomatous pathology | NA | 16 months ATT | 18 months | Healed | ||
| Khan et al.13 2003 English 1 patient |
13/F Lt SCJ pain and swelling for 11 months |
Xray- well defined lytic area in medial end of clavicle | FNAC- granuloma; AFB+; Culture+ | NA | 12 months ATT | 18 months | Healed | |
| Kawasaki et al.14 2007 Japanese 1 patient |
70/F Rt SCJ swelling |
CT- destruction of Rt SCJ | Biopsy+ | + | ATT and debridement when not healed at 3 months | NA | Healed | Past history of pulmonary TB |
| Sahu S15 2008 English 1 patient |
38/M Pain and swelling for 2 months |
Xray- moth-eaten appearance on medial end of clavicle, mild sclerosis of articular surface of manubrium; CT scan- lytic lesion involving Lt SCJ | FNAC- tubercular abscess | NA | 12 months ATT | NA | Healed | |
| Amano et al.16 2009 Japanese 1 patient |
79/M Lt precordial swelling |
CT- destruction of Lt SCJ | Needle biopsy- AFB seen | NA | ATT | NA | Improved | Renal failure due to rifampicin |
| Aggarwal et al.17 2009 English 1 patient |
22/M Rt Painful, swelling 4 month |
Xray- lytic lesion on Rt medial clavicle CT scan- erosion and fragmentation of medial clavicle |
FNAC- tubercular abscess | NA | 12 months ATT | 12 months | Healed | TB of wrist and bilateral sacroiliac joint. |
| Pandita et al.18 2010 English 1 patient |
62/F Swelling of both SCJ |
CT- fluid collections with erosion both ends | FNAC granuloma | NA | 12 months ATT | NA | Healed | Pleural effusion. |
| Shrivastav et al.19 2010 English 1 patient |
12/M Swelling Lt SCJ for 2 months |
Normal radiograph | FNAC- tubercular abscess; Culture- negative |
NA | NA | NA | Healed | |
| Grover et al.20 2011 English 2 patients |
53/M Pain and swelling Rt SCJ for 6 months |
Xray- osteolytic lesion; CT scan- expansion of clavicle with multiple erosions |
Curettage- granulomas | NA | NA | NA | NA | Pulmonary TB |
| 23/F Pain and swelling Lt SCJ for 2 months |
Xray- Lt SCJ dense sclerosis; CT -erosions of its articular surface with dense sclerosis |
CT guided aspiration-granulomas |
NA | NA | NA | NA | Sputum for AFB+; Pulmonary TB |
|
| Khare et al.21 2011 English 1 patient |
32/M Pain and swelling Lt SCJ |
Chest Xray- lytic lesion with sclerosis over medial aspect of clavicle | AFB + | NA | 12 months ATT | NA | Healed | |
| Kelderman et al.22 2012 English 1 patient |
24/F Swelling on medial aspect of Rt clavicle |
Normal radiograph | NA | + | ATT | NA | Healed | |
| Metanat M, Alavi-Naeini R23 2012 English 1 patient |
63Y/F Pain and swelling Lt SCJ for 7 months |
Xray- destruction of SCJ | FNAC- tubercular abscess; Culture- negative |
NA | ATT | NA | Healed | |
| Koshy S24 2014 English 1 patient |
28/F Pain Rt SCJ 10 months with multiple sinuses |
MRI - periosteal inflammatory condition | Culture + Resistance for INH |
NA | ATT | NA | At fifth month of ATT her sinuses reduced from 7 to 1 | Initially treated as bacterial infection |
| Saibaba et al.25 2014 English 1 patient |
24/F Painful swelling Rt SCJ of 2 months |
Xray- destruction and sclerosis of medial end of Rt clavicle | FNAC - caseating granuloma; AFB + | NA | 18 months ATT | 2 years | Healed | Pulmonary TB and spine TB |
| Walid et al.26 2015 English 1 patient |
63/M Swelling over Rt SCJ for 3 months |
Normal radiograph; CT-heterogeneously enhanced mass over Rt SCJ with widening of joint space and subchondral sclerosis of sternum | Histopathology+; Culture- |
NA | 12 months ATT | 4 years | Healed | |
| Jain et al.27 2015 English 13 patients |
29/F Swelling for 2 months |
Xray- normal | Histopathology +; Culture - |
+ | 12 months ATT | 17 months | Healed | 4 out of 13 patients had other site involvement(not specified which ones) |
| 34/F Painful swelling for 1 month |
Xray- normal | Histopathology +; Culture - |
– | 12 months ATT | 13 months | Healed | ||
| 44/M Discharging sinus for 3 months |
Xray- lytic lesion at clavicle | Histopathology -; Culture - |
+ | 18 months ATT | 21 months | Healed | Required immunomodulation; CD4:CD8 ratio-low | |
| 47/M Swelling for 7 months |
Xray- normal | Histopathology +; Culture - |
– | 12 months ATT | 12 month | Healed | ||
| 29/M Painful swelling for 4 months |
Xray- normal | Histopathology +; Culture - |
– | 12 months ATT | 14 months | Healed | ||
| 37/M Discharging sinus for 3 months |
Xray- normal | Histopathology -; Culture - |
– | 12 months ATT | 14 months | Healed | ||
| 41/M Swelling for 1 month |
Xray- normal | Histopathology +; Culture + |
– | 12 months ATT | 19 months | Healed | ||
| 33/F Painful swelling for 2 month |
Xray- normal | Histopathology -; Culture - |
– | 12 months ATT | 23 months | Healed | ||
| 39/M Swelling for 2 months |
Xray- normal | Histopathology -; Culture - |
+ | 12 months ATT | 18 months | Healed | ||
| 26/F Discharging sinus |
Xray- normal | Histopathology +; Culture - |
– | 18 months ATT | 22 months | Healed | Required immunomodulation; CD4:CD8 ratio-low | |
| 38/M Painful swelling for 2 months |
Xray- normal | Histopathology +; Culture - |
– | 12 months ATT | 16 months | Healed | ||
| 42/M Swelling for 1 month |
Xray- normal | Histopathology -; Culture - |
+ | 12 months ATT | 15 months | Healed | ||
| 36/M Discharging sinus for 3 months |
Xray- normal | Histopathology -; Culture - |
+ | 12 months ATT | 17 months | Healed | ||
| Akhtar et al.28 2015 English 1 patient |
41/F Painful swelling Rt SCJ |
Xray- normal; CT scan- sclerotic lesion on medial end of clavicle |
FNAC- inconclusive; Culture-; AFB- |
NA | 9 months ATT | 2 year | Healed | |
| Meena et al.29 2017 English 9 patient |
53/M Painful swelling Rt SCJ for 5 months |
Xray was normal in all except one who had doubtful cystic lesion at medial end clavicle and another had active disease in lung and spine | Biopsy- caseating granuloma | + | 16 months ATT | NA | Healed | 1 out of 9 patients had pulmonary and spine involvement |
| 24/M Painful swelling Rt SCJ for 2 months |
AFB + | + | 14 months ATT | NA | Healed | HIV+ | ||
| 51/M Discharging sinus Lt SCJ for 4 months |
AFB + | NA | 18 months ATT with immunomodulation for HIV | NA | Healed | |||
| 32/M Painful swelling for 7 months |
Biopsy- caseating granuloma | + | Second line ATT for 18 months with immunomodulation for HIV | NA | Healed | HIV+ | ||
| 58/F Painless swelling for 13 months |
Biopsy- caseating granuloma | NA | 18 months ATT | NA | Healed | Rheumatoid arthritis | ||
| 45/M Painful swelling for 6 months |
Biopsy- caseating granuloma | NA | 16 months ATT | NA | Healed | |||
| 65/M Discharging sinus for 6 months |
Biopsy- caseating granuloma | NA | 12 months ATT | NA | Healed | |||
| 33/F Painful swelling for 8 months |
Biopsy- caseating granuloma | + | 15 months ATT | NA | Healed | |||
| 54/M Painful swelling for 5 months |
AFB + | NA | 18 months ATT | NA | Healed | |||
| Jha et al.30 2018 English 3 cases |
49/M Swelling in Lt SCJ and fever |
CECT thorax- inflammatory lesion involving left SCJ with extension to mediastinum | NA | NA | 9 months ATT | NA | Healed | |
| 45/F Swelling in Rt SCJ and fever |
CECT thorax- cold abscess of Rt SCJ |
FNAC- grauloma; AFB+ | NA | 9 months ATT | NA | Healed | ||
| 36/F Swelling in Rt SCJ and fever |
CECT thorax- necrotic soft tissue swelling of Lt SCJ |
NA | NA | ATT | NA | NA | Pott’s spine at D6- D8 | |
| Prakash et al. 2019 English 19 cases |
14 of 19 were females. Pain in all patients |
Xray- varied appearances including diffused thickening and honeycombing, eccentric expansile lytic lesions with osteopenia, or sequestration at medial end of clavicle not unlike pyogenic infection. MRI- signal intensity changes, distended joint, granulation/abscess in the soft tissue. Few areas of cortical destruction |
Biopsy - caseating grauloma (all patients) | + in 16 out of 19 patients | 18 months ATT Curettage and debridement in 3 patients |
NA | Healed | 7 of 19 had past h/o pulmonary tuberculosis |
Abbreviations: ATT- Anti-tubercular therapy; AFB- Acid fast bacilli; CT-computed tomography; FNAC- Fine needle aspiration cytology; F- female; Lt- Left; M-male; MRI - magnetic resonance imaging; MTB- Mycobacterium tuberculosis; NA-not available; Rt- Right; SCJ-sternoclavicular joint; TB-PCR- Tuberculosis polymerase chain reaction; - denotes negative; + denotes positive.