PMC9277467_01
(a) Chest X-ray at admission. The permeability in the left middle and lower lung fields is decreased. The left diaphragm is elevated and the left costophrenic angle is dull. (b) Physical findings of the left anterior chest at the time of diagnosis. The left anterior chest is swollen without redness, and the nipple on the affected side is displaced to the upper left. (c) Initial enhanced chest computed tomography (CT) scan on the second day of admission. A low absorption lesion with a contrast effect is detected around the fifth rib, which suggested a chest wall abscess. Left pleural effusion with low volume is detected. (d) T2-weighted and T1-weighted + gadolinium (Gd) chest magnetic resonance imaging (MRI) on the 3rd day of admission. A high signal on T2-weighted images was observed from the anterior part of the left fifth rib to the transitional part of the costal cartilage. (e) T2-weighted and gadolinium-enhanced chest MRI on the 15th day of admission. The size of the abscess around the left fifth rib is greatly reduced. A contrast-enhanced area can be seen from the anterior part of the left fifth rib to the transitional part of the costal cartilage, resulting in the diagnosis of left fifth rib osteomyelitis. (f) Physical findings of the left anterior chest at the time of after 38 days of treatment. Swelling around the left fifth rib and papillary deviation are improving. (g) T2-weighted and gadolinium-enhanced chest MRI on after 38 days of treatment. The contrast area of the anterior portion of the fifth rib to the costochondral transition of the ribs is also reduced.
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Chest X-ray on the day of admission showed a cardiothoracic ratio of 55%; the left costophrenic angle was dull, and permeability of the left middle and lower lung fields was decreased (Figure 1(a)). A physical examination revealed slight swelling on the left anterior chest; her mother had been unaware of the swelling before admission (Figure 1(b)). Additionally, mild left pleural effusion was detected (Figure 1(c)). MRI findings showed a 30-mm-large mass in the costochondral transition of the left fifth rib, extending across the ribs to the chest wall and thoracic cavity (Figure 1(d)). On the 15th day of hospitalization, contrast MRI was performed to evaluate for osteomyelitis (Figure 1(e)). Follow-up MRI at 38 days after starting treatment showed that the inflammation around the left fifth rib had improved, and no recurrence was detected (Figures 1(f) and 1(g)).