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Images in paediatrics
A rare clavicular lump in a baby: congenital pseudarthrosis
  1. Andrea Gritz1,
  2. Nick Owen2,
  3. Elinor Sefi1
  1. 1 Department of Paediatrics, The Whittington Hospital, London, UK
  2. 2 Department of Radiology, The Whittington Hospital, London, UK
  1. Correspondence to Dr Andrea Gritz, Paediatric Critical Care Unit, The Royal London Hospital, Whitechapel Road, London, E1 1BB; andrea.gritz{at}nhs.net

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A 15-day-old baby presented to the accident and emergency department after her mother noticed a lump over the right clavicle. She was born at term, birth weight 3.5 kg, by uncomplicated caesarean section and had reportedly been moving both arms freely since birth.

Examination revealed a non-tender, 1×1 cm protuberance over the right mid-clavicle. Suspecting a fracture, an X-ray was taken, which identified a bony defect without any evidence of callus formation (figure 1). An ultrasound confirmed the suspicion of congenital pseudarthrosis of the clavicle.

Figure 1

Plain film showing bony defect of the right mid-clavicle. Note the smooth, well-defined ends of the medial (solid arrow) and lateral (dashed arrow) clavicle and absence of callus formation.

Congenital pseudarthrosis of the clavicle is rare. A study from 2000 showed that just 200 cases had been reported.1 It usually affects the right clavicle and has a female preponderance.2 Embryologically, the two primary ossification centres of the clavicle fail to unite.3 Aetiology is unknown but one popular hypothesis points towards extrinsic compression by the pulsatile subclavian artery.4 Radiographic findings are characteristic, with clear separation in the mid-clavicle. Fragment ends are rounded and the absence of callus formation differentiates it from a healing fracture. If there are concerns regarding an acute fracture, repeat radiographs after 10–14 days will confirm ongoing absence of healing reaction.

The protrusion usually becomes more prominent with age. Later in childhood, there may be pain and functional impairment, ranging from fatigue or discomfort with strenuous activity to more severe disability. Surgical management may be considered.

Congenital pseudarthrosis forms an important differential diagnosis, alongside accidental and non-accidental injury, in babies presenting with painless clavicular lumps shortly after atraumatic births, particularly if they can move their arms freely.

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Footnotes

  • Contributors AG wrote the manuscript. NO made the radiological diagnosis and optimised the image for this article. ES was involved in management of the patient and obtained parental consent. All three authors approved the final version of the manuscript.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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