Study of Neck Abscess from Septic Sternoclavicular Arthritis

Abstract

Conditions causing upper respiratory tract inflammation, including tonsillitis, dental infections, and airway foreign bodies, can result in cervical abscesses. Sternoclavicular septic arthritis is usually treated by orthopedic surgeons, but rarely causes cervical abscesses. We treated two patients with cervical abscesses. The first patient was a 69-year-old woman complaining of a 2-week history of fever and swelling on her left anterior thorax. Computed tomography (CT) showed an abscess extending from neck to mediastinum primarily around the sternoclavicular joint. Following admission, incision and drainage of the abscess with tracheostomy placement was performed under general anesthesia. Thirteen days after surgery, swelling reappeared on the patient’s anterior chest. At that time, osteomyelitis of the left clavicle and sternum was diagnosed by CT. Curettage of the clavicle was considered, but the patient refused treatment. Thirty days after surgery, an anterior cervical incision was made under local anesthesia, but there was no obvious sign of infection. The patient was discharged on postoperative day 50. The second patient was a 73-year-old woman complaining of a 1-week history of pain at the right sternal border. A right cervical abscess and mediastinal abscess were diagnosed by CT. After admission, incision and drainage was performed on both abscesses by a respiratory surgeon under general anesthesia. Osteomyelitis of the right clavicle was diagnosed by magnetic resonance imaging (MRI). The postoperative course was uneventful, and the patient was discharged on postoperative day 32. An abscess near the sternoclavicular joint requires evaluation with CT or MRI to differentiate cervical abscesses, mediastinal abscesses, and osteomyelitis. Sternoclavicular septic arthritis is rarely encountered in the routine practice of otolaryngology; however, it is essential to know that it can cause a cervical abscess. It is important to consider multidisciplinary approach during treatment based on the degree of inflammation.