PMC5292989_01
Sonogram of the epigastric region using a high-frequency transducer shows increased thickness and echogenicity of soft tissue. Focal area of hypo-echogenicity (red arrow) is seen in the deeper plane with linear echogenic foci (white arrows) on its posterior aspect. These appearances were suggestive of bone fragments with surrounding cold abscess.
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The hypoechoic collection showed linear echogenic bone fragments located on its posterior aspect (Figure 1).
Lateral chest radiograph showing complete destruction of the xiphoid process (white arrow).
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Subsequently, Lateral chest radiographs focused at the distal sternum were obtained, demonstrating lytic destruction of the xiphisternum (Figure 2).
CT thorax: sagittal reformatted bone window view, shows complete erosion of the xiphisternum with surrounding soft tissue stranding (white arrow).
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The surrounding soft tissue revealed poorly-enhancing inflammatory changes in the form of stranding (Figure 3).
CT thorax: coronal reformatted lung window view, shows traction bronchiolectasis along the horizontal fissure in the right lung and posterior basal segment of the left lung (white arrows) with multiple fibrotic nodules in bilateral lung parenchyma.
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Additionally, traction brochiolectasis was observed in the right upper lobe and left lower lobe suggesting an old infective etiology (Figure 4).
T1W axial (A) and sagittal (B) contrast-enhanced MRI at the level of the xiphisternum shows (A) encapsulated enhancing abscess (white arrow) with (B) surrounding soft tissue stranding (white arrow).
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MRI demonstrated abscess formation in the soft tissue of the xiphisternal region (Figure 5A, 5B). MRI also helped to exclude concurrent spinal tuberculosis.