Methods
Differential Diagnosis
- Sternal osteomyelitis
- Soft tissue abscess
- Costochondritis
Investigations
- Laboratory findings:
- Total leukocyte count: 12,000/mm³
- Erythrocyte sedimentation rate: 44 mm/hr
- Reactive C-reactive protein (++).
Imaging:
- X-ray (lateral view): Normal on initial evaluation (Figure 1).
- Ultrasonography: Hypoechoic fluid collection adjacent to the sternum
(Figure 3).
-Procedures:
- Ultrasonography-guided aspiration yielded blood-tinged purulent fluid.
- Culture identified *Staphylococcus aureus*, sensitive to clindamycin.
Treatment
- Intravenous flucloxacillin and clindamycin during the first week.
- Transitioned to oral clindamycin for five additional weeks.
Outcome and Follow-Up
The patient became afebrile by the third day of hospitalization.
Follow-up evaluation at 1 week showed no complaints, reduced
inflammatory markers (CRP negative, ESR 7 mm/hr), however X-ray sternum
lateral showed periosteal reaction (figure 2).Thereafter antibiotics
were continued until 6 weeks and repeat X-ray at the same time was
normal(figure 4).