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Bull’s head sign in the scintigraphy of a young female with recurrent chest pain
Affiliations- Military Medical Academy Memorial Teaching Hospital of the Medical University of Lodz — Central Veterans’ Hospital, Lodz, Poland
- Department of Rheumatology, Medical University of Lodz, Lodz, Poland
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Abstract
In this case we report a 38-year-old female patient with history of recurrent retrosternal chest pain lasting almost 5 years. Standard X-rays of chest and spine revealed no abnormalities. In a physical examination tenderness of anterior chest wall was observed, especially in sternoclavicular areas. SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome was taken into consideration despite of lack of typical skin lesions (acne, pustulosis). We decided to implement [99mTc]Tc-MDP scintigraphy. Increased osteoblastic activity (intense [99mTc]Tc-MDP) in manubriosternal and both sternoclavicular regions represents bull’s head sign which is a rare finding, but pathognomonic to SAPHO syndrome. After a 3-month therapy with aceclofenac 100 mg, total remission was reached. If we rule out this rare condition like SAPHO based on lack of abnormalities in X-rays, the reason of symptoms could be still unrecognized. [99mTc]Tc-MDP scintigraphy is valuable to show even subclinical areas of involvement and to monitor treatment response in SAPHO syndrome. This case proved significant role of whole body scintigraphy to make diagnosis of SAPHO syndrome in patients with non-cardiac chest pain and lack of abnormalities in standard X-rays.
Abstract
In this case we report a 38-year-old female patient with history of recurrent retrosternal chest pain lasting almost 5 years. Standard X-rays of chest and spine revealed no abnormalities. In a physical examination tenderness of anterior chest wall was observed, especially in sternoclavicular areas. SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome was taken into consideration despite of lack of typical skin lesions (acne, pustulosis). We decided to implement [99mTc]Tc-MDP scintigraphy. Increased osteoblastic activity (intense [99mTc]Tc-MDP) in manubriosternal and both sternoclavicular regions represents bull’s head sign which is a rare finding, but pathognomonic to SAPHO syndrome. After a 3-month therapy with aceclofenac 100 mg, total remission was reached. If we rule out this rare condition like SAPHO based on lack of abnormalities in X-rays, the reason of symptoms could be still unrecognized. [99mTc]Tc-MDP scintigraphy is valuable to show even subclinical areas of involvement and to monitor treatment response in SAPHO syndrome. This case proved significant role of whole body scintigraphy to make diagnosis of SAPHO syndrome in patients with non-cardiac chest pain and lack of abnormalities in standard X-rays.
Keywords
bull’s head sign; chest pain; [99mTc]Tc-MDP scintigraphy
About this articleTitle
Bull’s head sign in the scintigraphy of a young female with recurrent chest pain
Journal
Issue
Vol 26 (2023): Continuous Publishing
Article type
Clinical vignette
Pages
36-37
Published online
2022-12-28
Page views
2884
Article views/downloads
336
DOI
Bibliographic record
Nucl. Med. Rev 2023;26:36-37.
Keywords
bull’s head sign
chest pain
[99mTc]Tc-MDP scintigraphy
Authors
Anna Drelich
Adam Lentas
Joanna Makowska
References (4)- Habib PA, Huang GS, Mendiola JA, et al. Anterior chest pain: musculoskeletal considerations. Emerg Radiol. 2004; 11(1): 37–45.
- Frieling T. Non-Cardiac Chest Pain. Visc Med. 2018; 34(2): 92–96.
- Fass R, Achem SR. Noncardiac chest pain: epidemiology, natural course and pathogenesis. J Neurogastroenterol Motil. 2011; 17(2): 110–123.
- Duan Na, Chen X, Liu Y, et al. Multimodal imaging findings of SAPHO syndrome with no skin lesions: A report of three cases and review of the literature. Exp Ther Med. 2016; 12(4): 2665–2670.
