anterior chest pain a musculoskeletal perspective chest pain.pdf · sternocostoclavicular...
TRANSCRIPT
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Anterior Chest Pain
a musculoskeletal
perspective
Dr Shrenik M Shah
Shrey hospital
Ahmedabad
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Etiology
Cardiac and pleural causes ruled out
traumatic,
rheumatologic,
inflammatory,
Infectious,
neoplastic
Refered pain
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Differential diagnosis
fractures and dislocations,
Stress fractures,
arthritis,
costochondritis,
Sternocostoclavicular hyperostosis,
condensing osteitis,
infection,
muscle tears,
tumors.
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Imaging
X- ray chest-Properly exposed upright posteroanterior and lateral radiographs made in full inspiration
Lateral view for sternum
CT/MRI:Sternum and sternoclavicular joints, or a dedicated bone-detail rib series for evaluation of the ribs
Bone scan-for assessing metabolic processes that increase bone turnover or produce an inflammatory response.
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Sternum
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Sternum fracture on CT
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Sternal stress fracture in F/54 yrs
with Ca breast
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Rheumatogic diseases
Sternoclavicular joint: 3rd decade-deg changes
manubriosternal articulation- OA chages with vacuum phenomenon
RA and crystal disease
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Costochondritis
Prevalence rate -30% in emergency chest pain
capsulitis in the absence of true arthropathy
Bone scan
Usg
LAHC
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Sternoclavicular hyperostosis
4TH - 5TH decade
Hyperostosis and soft tissue ossification of the clavicle, anterior portion of the upper ribs, and sternum
SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteomyelitis
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Condensing osteitis of the clavicle
F/ 20-50
Stressful activities
eburnation,
mild enlargement of the inferomedial aspect of the clavicle
osteophytosis,
surrounding soft tissue swelling
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infection
intravenous drug abuse Sterno
clavicular Joint
Sternum and manubrio sternal Joint-hematogenous inoculation or secondarily from a surgical or therapeutic procedure, such as central venous catheteraization
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Muscle tears
Throwing injuries: shoulder girdle, pec major and lat dorsi
Muscle strains- tears easily picked up on usg
CT- bony avulsions
MRI- for detecting hematoma or interstitial hemorrhage
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Tumours
Primary in sternum-rare -plasma cell
myeloma, lymphoma, and chondrosarcoma.
Haemopoietic marrow in sternum-common site for metastasis
Advanced imaging for staging tumour
X-ray for follow up
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Clinical case
M / 50 yrs
Episodic chest pain, severe and fear of cardiac disease
Extensive investigations-all normal
GERD
Stamped as functional
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costochondritis
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Pip joint synovitis with erosions
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Final diagnosis
Rheumatoid arthritis according to newer guidelines of ACR 2010
Started on DMARDs to prevent joint damage and ease pain.