0:00

<v ->Chest wall involvement.

0:03

Although we can see this in rheumatoid,

0:06

the more extensive chest wall involvement

0:09

occurs in the spondyloarthropathy

0:11

and that includes the sternoclavicular joint

0:14

and the sternomanubrial joint as well.

0:18

And what you're gonna see

0:19

is irregularity of the opposing bone surfaces,

0:22

bone proliferation,

0:24

and extensive marrow edema

0:26

as in this particular case.

0:28

Now there are other conditions

0:30

and I had to find a place for

0:32

these two cases I'm going to show you.

0:34

There are other conditions that involve the chest wall.

0:38

And one of the very interesting ones,

0:40

and I'll take a moment to describe it is this.

0:43

Boy, that's a long name.

0:45

Sternocostoclavicular Hyperostosis, often abbreviated SCCH.

0:51

It's seen in older people.

0:54

It's a condition associated with bone proliferation

0:57

involving the medial ends of the clavicles,

1:00

the adjacent sternum, the upper ribs,

1:03

and the intervening soft tissue.

1:05

So you'll see this

1:06

bizarre bone proliferation at those sites,

1:09

and you can see sternomanubrial involvement as well.

1:14

I can tell you when you see this disease

1:16

on a chest radiograph,

1:18

you'll make the mistake that I made and call it lymphoma,

1:21

thinking you're dealing with mediastinal adenopathy,

1:25

but you're dealing with ossification about this chest wall.

1:30

And in some of those cases,

1:31

you'll end up with bone proliferation in the spine

1:35

resembling either ankylosing spondylitis,

1:38

or even DISH.

1:40

So that's an example of this condition.

1:43

Now what's interesting about it,

1:45

if you talk to the patients,

1:46

many of them will tell you

1:48

that they had pustular skin lesions

1:51

on their hands and feet.

1:53

The exact diagnosis

1:55

pustulosis palmaris et plantaris.

1:59

And it's the association of pustular skin lesions

2:02

with bone proliferation.

2:05

You see it in pustular psoriasis as well.

2:08

That is carried forth in this diagnosis.

2:11

We have a fancy name for that association.

2:14

We call it SAPHO syndrome,

2:17

S-A-P-H-O.

2:20

Synovitis, acne, pustulosis, hyperostosis, osteitis.

2:24

This is one of the conditions that falls

2:27

under this particular name SAPHO.

2:31

There are others, you may know them.

2:33

For example,

2:34

chronic recurrent multifocal osteomyelitis is one of them.

2:39

But in any case,

2:41

this is one of the conditions tying together

2:43

pustular skin lesions

2:46

with involvement of bone,

2:48

particularly the chest wall.

2:50

Here's another case.

2:52

You'll know it here,

2:54

a lot of chest wall involvement, but look,

2:56

the spine is involved.

2:58

A lot of spine involvement.

2:59

We have involvement of scapula,

3:02

ribs may be involved.

3:04

So this is a subset of SAPHO.