[Intrathoracic lipoma of the pleural cupula].
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Between 1986 and 1989, we conducted a clinical, biochemical, radiological and scintigraphic prospective study of 15 patients (8 men, 7 women) with histologically proven palmoplantar pustulosis. In 70 percent of the cases the time interval between the first cutaneous and the first osteoarticular signs was 2 years. Anterior thoracic clinical manifestations were frequent. The joints and the numbers of patients involved were: sternoclavicular (12), manubriosternal (6), sternocostal (5), intervertebral (11), sacroiliac (6) and peripheral (10). Two patients had osteitis. The clinical, radiological and scintigraphic findings, as well as the distribution of these arthropathies over the anterior thorax (i.e. over a sternocostoclavicular complex with numerous ligaments), suggest a preference for entheses. Despite the absence of link with the HLA B27 antigen, the frequent association with pelvic and spinal lesions indicate that the articular disease of palmoplantar pustulosis is a spondyloarthropathy.
The precise pathogenesis of discovertebral lesions in rheumatoid arthritis has long been debated with the emergence of 2 conflicting theories: discovertebral extension of synovial inflammation from a neighboring articulation (Luschka, costovertebral joint) and repetitive discal trauma with Schmorl's nodes. In order to address this controversy, we performed a radiographic-pathologic correlation of a rheumatoid cadaver and compared the alterations seen in the cervical and lumbar discovertebral junction; we further included an evaluation of the manubriosternal joint, another cartilaginous articulation. Our data confirmed that advanced discovertebral lesions in the cervical and lumbar spine are related primarily to endplate failure that itself is caused by apophyseal joint destruction and segmental spinal instability, although inflammatory rheumatoid lesions of the cervical intervertebral discs probably arising from the Luschka joints are also evident. Conversely, the lesions of the manubriosternal joint were produced by inflammatory changes related to the development of a synovial cavity in the articulation.
A case of chronic dislocation of the manubriosternal joint (MSJ) is presented. There was no history of spinal trauma, thoracic kyphosis or rheumatic joint disease. The patient had had an excision of an abnormal second chondrosternal joint before the MSJ dislocation became evident. After a failure to fix the joint by plating and wiring, fusion was achieved by the use of artificial bone graft and a polymethylmethacrylate implant. Pathological factors leading to this condition are reviewed.
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Monarthritis of the manubriosternal joint is a known but uncommon disease. A case is presented with the tissue type HLA-B27 and monarthritis of a persistent transverse articulation of the sternal body. To our knowledge this is a unique case, but with the same etiology as similar changes of the manubrio-sternal joint.
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Infection of the manubriosternal joint is an exceedingly rare event. We report a case of a 38-year-old patient with systemic lupus erythematosus who developed staphylococcal septic arthritis of this joint after bacteremia. Pathogenic factors are discussed. Physicians should be aware of this unusual complication of staphylococcal bacteremia.
A patient is described in whom subluxation and erosions were present in the manubrio-sternal joint. The literature relating to the manubrio-sternal joint in rheumatoid arthritis is reviewed.
The essential articular pathology of AS may be said to reflect the occurrence, severity, and overall bias of (a) synovitis which tends to produce articular erosion, and (b) an inflammatory enthesopathy which results in capsular ossification in diarthrodial joints and syndesmophyte formation in cartilaginous joints, both of which are primarily responsible for bony ankylosis. Nonspecific secondary mechanisms contribute to the final picture. These include enchondral ossification, which produces synostosis, osteoporosis and altered stress distribution which make the axial skeleton susceptible to trivial trauma, the destructive effects of which are sometimes described as spondylodiskitis.
Radiological study of conjoined thoracopagus twins. The digestive and biliary tracts, the urinary and cardiovascular systems have been examined. The problems and difficulties encountered in the various procedures and in the interpretation of their results are described.
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Six patients (4 male and 2 female) presenting with an original, predominantly osseous disease are reported. The disease is characterized by a chronic inflammatory process affecting the thorax, the spine, the femur in 1 case and in all patients only one of the sacro-iliac joints. The condition had begun 11 to 28 years previously and had been active for 6 to 24 years. One case started with regressive polyarthritis. There was no visceral involvement. Radiograms showed bone condensation with hyperostosis, sometimes hypertrophic, unrelated to any articular space. Depending on each patient, the lesions involved the clavicles, the sternum, the posterior arch of the ribs, the vertebrae, the inferior femoral metaphysis. The only joints involved were the sacro-iliac and anubrio-sternal joints. The areas affected showed high radioisotope uptake. There was discrete biochemical inflammatory syndrome. Three of the 6 patients belonged to the HLA group B 27. The multiple biopsies performed showed no specific lesions. The disease proceeds by successive attacks lasting several months and responding poorly to anti-inflammatory drugs. One patient developed Crohn's disease, another, retroperitoneal fibrosis. In some respects, this condition is remindful of sterno-clavicular hyperostosis and of the osteo-arthropathy in palmoplantar pustulosis or acne conglobata. It seems to constitute a new variety of spondylo-arthropathy intermediate between the above-mentioned diseases and genuine ankylosing spondylitis.
A case of manubriosternal dislocation is presented. The possible mechanism of injury was hyperflexion of the spine which resulted in chin to chest contact, disrupting the manubriosternal joint. If the dislocation is Type I and the patient has compression symptoms on the trachea or major vessels, surgical treatment by wiring may be needed. In Type II dislocations, the best management is closed reduction and elastoplast strapping.