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Arch Dis Child doi:10.1136/archdischild-2012-303187
  • Images in paediatrics

Clavicular swelling—classic presentation of chronic non-bacterial osteomyelitis

  1. A V Ramanan1
  1. 1Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
  2. 2Department of Paediatrics, Royal Exeter and Devon NHS Foundation Trust, Exeter, UK
  3. 3Department of Radiology, Royal Exeter and Devon NHS Foundation Trust, Exeter, UK
  1. Correspondence to Dr A V Ramanan, Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8AE, UK; avramanan{at}hotmail.com
  • Received 13 October 2012
  • Revised 29 October 2012
  • Accepted 4 November 2012
  • Published Online First 6 December 2012

An 11-year-old boy presented with a 12 month history of progressive right clavicular swelling (figure 1). Clinical examination raised a differential diagnosis to include osteomyelitis and malignancy.

Figure 1

Photograph showing swelling of medial aspect of right clavicle.

Radiographic examination showed marked enlargement of the medial half of the clavicle (figure 2), with layered periosteal reaction. CT and MRI of the lesion showed lytic, destructive, expansile bone lesion, indicative of aggressive nature (figure 3). Bone …

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