The aim of this paper is to discuss the method of treatment for septic sternoclavicular (SG)arthritis, based on combined MR findings retrospectively. [Case 1] A 40-year-old female complained of pain in her right SC joint. The X-rays were normal. The T1-weighted images showed low signal in the right clavicle and SC joint. Short-tau inversion-recovery (STIR) showed high signal in the right clavicle and SC joint. Operative findings revealed lytic change of the cortical bone, and showed abnormal granulation in the bone marrow and surrounding SC joint. She underwent a curettage and continuous irrigation. [Case 2] A 50-year-old female on hemodyalysis complained of pain over her left SC joint. X-rays showed a lytic change in the clavicle. T1- weighted images and STIR showed the same signals as in case 1. Operative findings revealed osteomyelitis and arthritis of the SC joint. A curettage and continuous irrigation were performed. [Case 3] A 21-year-old female with systemic lupus erythematosus complained of pain in the right clavicle. The X-ray, T1-weighted and STIR images were normal. Gd-DTPA enhanced MR images (Gd) showed an enhanced area in the SC joint. The operative findings showed a proliferation of synovial tissue. She underwent debridement and continuous irrigation. [Case 4] A 54-year-old male with liver cirrhosis complained of pain in the left clavicle. Gd images revealed an enhancement of the abscess wall in the surrounding SC joint. The Operative finding showed an abscess forming in the surrounding SC joint. We treated him with a debridement. Discussion: Early and aggressive surgical therapy is important, especially in the immunocompromised host because arthritis can cause mediastinitis and sepsis. We evaluated the treatment, based on our operative findings and combined MR images. If the MR images showed osteomyelitis, we recommended a debridement and continued local drainage. If MR images revealed normal appearance of the clavicle, we treated them conservatively. If the Gd images showed an enhancement of the abscess wall in the surrounding SC joint without osteomyelitis. Our strategy should be analyzed more because our study included only 4 patients, but our combined MR images were helpful in diagnosis and choosing the treatment.
