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The patient was a 10-year-old girl with pain and swelling of the left clavicle. The physical examination was normal except swelling and tenderness of the left clavicular region. All the laboratory tests were in normal range (white blood cells=6.13×109/L, haemoglobin=128 g/L, platelet=409×109/L, Wright=negative and Coomb’s Wright=negative) except mildly elevated erythrocyte sedimentation rate (ESR=42 mm/hour) and C reactive protein (CRP=11 mg/L). Chest X-ray revealed the enlargement of the medial third of the left clavicle along with periosteal reaction (figure 1A). The imaging findings proposed osteomyelitis and/or Ewing sarcoma. Thus, the patient underwent left clavicle bone biopsy which showed fragments of bony trabecula with mixed inflammatory cells infiltration, fibrosis and new bone formation (figure 2). The histopathologic findings were in favour of osteomyelitis. Thus, the physicians started empirical antibiotic therapy and waited for tissue culture result. The tissue culture was negative and the patient’s symptoms did not improve even after a course of antibiotic therapy. The clavicular lesion progressed and extended laterally during several months (figure 1B). MRI showed hypointensity on T1-weighted images and …
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