化膿性胸鎖関節炎の2例

Septic Arthritis of the Sternoclavicular Joint. Report of Two Cases

　CTガイド下穿刺が有用であった化膿性胸鎖関節炎の2例を経験した．胸鎖関節に炎症所見を認め，CTで胸鎖関節の破壊，MRIで胸鎖関節の信号変化を認めた．化膿性胸鎖関節炎と診断し，CTガイド下で穿刺し，ドレナージ，抗生剤投与によりCRPは沈静化した．培養では黄色ブドウ球菌，表皮ブドウ球菌が検出された．化膿性胸鎖関節炎で溶骨像や骨髄炎を認める場合，外科的治療の適応となるが，本例では保存的治療で良好な結果が得られた．CTガイドの利点として，正確な位置へのドレーン留置，気胸などの合併症予防が挙げられる．

　We report two cases of septic arthritis of the sternoclavicular joint that were treated using computed tomography (CT)-guided aspiration. Inflammation was observed around the sternoclavicular joints,and CT and magnetic resonance imaging (MRI) examinations showed septic arthritis and the destruction of the joints. Both patients underwent CT-guided aspiration,drainage,and antibiotics therapy,and the CRP level decreased. Culturing of the abscess aspirates revealed Staphylococcus aureus and Staphylococcus epidermis. Although surgical therapy is usually employed when evidence of the destruction or osteomyelitis of the sternoclavicular joint exists,we were able to treat the present two cases using conservative therapy. Drain tubes were appropriately positioned,and complications like pneumothorax were avoided.