CTICasesSeptic Arthritis of the Costomanubrial Joint
Imaging findings
Chest radiograph shows a large left apical soft-tissue density. Chest CT demonstrates a large, complex fluid and gas collection in the chest wall, centered on the first costomanubrial/costochondral joint, with extension of the abscess under the pectoralis muscle. The joint space is widened and contains nitrogen gas bubbles. Culture yields MRSA.
Key takeaways
Septic arthritis of the costomanubrial or sternoclavicular joints is a well-known infectious complication in intravenous drug abusers. Organisms seed the joint hematogenously, leading to osteomyelitis, cartilage destruction, and large chest wall abscesses. On CT, the infection is centered on the joint and can contain gas (which is often redistributed normal joint nitrogen gas), requiring surgical drainage and antibiotics.
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