Age / Sex : 30 / F

Chief complaint : abnormality on chest X-ray


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Courtesy : 문승규 (Sung Gyu Moon), 건국대병원 (Konkuk University Hospital)

Osteitis condensans of the clavicle

Discussion

Findings
Radiograph: right clavicle proximal end sclerotic lesion, mimicking lung nodule
CT axial: Focal sclerosis in proximal end of right clavicle, without bone erosion or soft tissue swelling
CT coronal: Sclerosis of the inferior aspect of the medial third of the clavicle, typically unilateral. No sternoclavicular joint space narrowing or erosions.

Discussion
Osteitis condensans of the clavicle is characterized by benign sclerosis of the inferomedial third of the clavicle. Its radiological appearance is homologous to that of the similarly-named osteitis condensans ilii, although no association has been reported.
It usually affects women of childbearing age. It can present with pain on the abduction of the arm and localized swelling. Unlike osteitis condensans ilii, it is usually unilateral. The syndrome seems to be a response to mechanical stress.
Histology reveals thickened trabeculae, with both lamellar and woven components. Devitalised bone is present, suggesting remodeling. Periosteal reaction is often seen histologically. It carries a good prognosis. Pain can usually be managed with anti-inflammatory drugs.
Plain radiograph and CT: Sclerosis of the inferior aspect of the medial third of the clavicle is seen, typically unilateral. It can sometimes be associated with a small osteophyte, but should never be associated with subchondral cysts, joint space narrowing or erosions.

References
Rand T, Schweitzer M, Rafii M, Nguyen K, Garcia M, Resnick D. Condensing Osteitis of the Clavicle: MRI. J Comput Assist Tomogr. 1998;22(4):621-4.
Greenspan A, Gerscovich E, Szabo RM, Matthews JG 2nd. Condensing osteitis of the clavicle: a rare but frequently misdiagnosed condition. AJR Am J Roentgenol. 1991;156(5):1011-5.
Davis TA, Garcia J, Mosquea TRJ, Zarate SD, Renshaw AA, Belzarena AC. Sclerosis of the clavicle--A challenging diagnosis. Radiol Case Rep. 2022;17(7):2362-2366.