PMC6821478_01
Ultrasound of soft parts of right and left costal frameworks,
respectively. (A) To the right, unchanged; (B) to the left, a volumetric
increase of the costochondral joint is seen, with free intra-articular
fluid and irregularity of the anterior end of the costal arch.
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Ultrasound of soft tissues (Figure 1) showed volumetric increase of the costochondral joint with free intra-articular fluid and irregularity of the costal arch's anterior end.
Bone scintigraphy - 99mTC-HMDP radiopharmaceutical. (A) and (B)
initial images: focal hyperaemia in middle anterior region of left
costal scaffold; (C) and (D) late images: hypercaptation of
radiopharmaceutical in topography corresponding to the focus of
hyperemia identified in the diffusion phase and area of hypofixation of
the radiopharmaceutical upon topography of respective costochondral
joint.
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Three-phase 99mTc-HMDP bone scintigraphy (Figure 2) showed focal hyperemia in the left anterior mid-arch of the left costal arch and, in late images, high uptake of the radiopharmaceutical in topography corresponding to the focus of hyperemia identified in blood diffusion phase and area of hypo fixation of the radiopharmaceutical upon respective costochondral joint topography, aspects compatible with inflammatory/infectious pathology.
Ultrasound of left costal arch soft tissues of the. An irregularity
of the anterior extremity of the arch is observed, although it shows
sclerotic borders of apparently continuous form, with aspect suggesting
consolidation.
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Oral amoxicillin-clavulanic acid (70 mg/kg/day) was initiated, completing six weeks of antibiotic therapy, presenting at the time of resolution of the palpable swelling sedimentation rate at 10 mm/1st hour, CRP lower than 0.1 mg/dL (Table 1) and control ecography showing irregularity of the costal arch's anterior extremity, although sclerotic borders of apparently continuous form and aspects suggestive of consolidation were seen (Figure 3).