LETTER

Condensing
osteitis of the

clavicle

right shoulder two and a half years after the
chest pain incident, Chest radiographs taken
atthis time revealed no change in appearance
or size of the dense clavicular lesion.

Ofl6 histologicallyproven cases, all occur-
ring in women mostly presenting in the fourth
or fifth decades (age range 26-63), only two
were asymptomatic with the lesiondiscovered
serendipitously' as was the situation in the
abovecase

Condensing osteitis of the clavicle is an
important condition to recognise as the plain
films should be diagnostic and no further in-
vestigation should generally be required. The
important condition to consider in the dif-
ferential diagnosis is a solitary sclerotic meta-
static deposit which would require further
investigation.

Although the above patient was asymp-
tomatic, some patients do have severe pain
andnon-steroidalanti-inflammatorymedi-
cation may be required. In some patients
where the pain is refractory, excision of the
medial third of the clavicle may be necessary
as a last resort.'

To the Editor:

The article on the very rare condition of
condensing osteitis of the inferomedial aspect
of the clavicle' was most interesting and
prompts the following short case notes.

A43 year old woman with a history of
left chest pain was referred for radiographs
of the chest and thoracic spine which dem-
onstrated a "coin lesion" overlying the
inferomedial aspect of the right clavicle. On
the frontal chest radiograph the lesion
appeared to be within the
medial clavicle, but on the
antero-posterior thoracic
spine film the nodule ap-
peared to be intrapulmonary
in location due to a superim-
posed vessel which seemed to
be part of the "coin lesion".

The dilemma was expe-
ditiously resolved by taking
radiographs specifically an-
gled to show the medial clavi-
cle which confirmed that the
rounded sclerotic lesion was
intraclavicular in location. No
associated inferomedial bony

spur or osteophyte was demonstrated,
there was no soft tissue swelling and the
sternoclavicular joint was normal.

Ofparticularinterestwas that the patient
had had no pain or soft tissue swelling related
to the medial aspect of the right clavicle.No
history of previous trauma was elidted.Two
years before the presentation of chest pain she
had experienced right sided shoulder
pain,andshe again presented with pain in the

WFC van Gelderen
FFRad(D) (SA)
Consultant Radiologist
DepartmentofRadiology
vtánganui Base Hospital
Wang;mui
New Zealand
References
1. Ooi GC, Pch WCG. Condensing osteitis of the clavi-
cle. SouthAfrican Journal of Radiology. I 996; 1 [21:25-27.
2. Greenspan A, Gerscovich E, Szabo RM, Mathews If
JG. Condensing osteitis of the clavicle: a rare but fre-
quently misdiagnosed condition. American loumal of
Rxn~1991;156:10l1-1015.

Figure 1: Close up view of right clavicle on frontal chest radiograph
demonstrates rounded sclerotic area involving inferomedial aspect of
right clavicle consistent with sclerosing osteitis (arrows)

Maurice
VVeinbren
Award in
Radiology
1996

The award isoffered annually (in respect
of a calendar year) by the Council ofThe
College ofMedidne of South Africa for a
paper ofsuffident merit dealing either with

radiodiagnosis radiotherapy, nuclearmedi-
doe or diagnostic ultrasound.

TIle award consists of a Certificate and a
MOOal.

The closing date is 15 February 1997. TIle Guidelines pertaining to the award can be ob-
tained from the Executive Secretary, Mrs Bemise Bothma at 17 Milner Road, Rondebosch,
7700orTcI: (021) 689-3161,Fax: (021) 68S-3766,E-mail:cmsa·adm@iafrica.com

25 SA JOURNAL OF RADIOLOGY. November 1996