肋間開胸術後に発症した肋骨骨髄炎・肋軟骨炎

Costochondritis and Osteomyelitis of the Ribs after Intercostal Thoracotomy

肋骨骨髄炎・肋軟骨炎は，肋間開胸術後では非常にまれな胸壁の感染症であるが，ひとたび発症すると治療に難渋する．われわれは，特発性食道破裂に対する肋間開胸術後に発症した肋骨骨髄炎・肋軟骨炎を経験したので報告する．

A 53-year-old man underwent surgical repair and drainage of a spontaneous esophageal rupture through a left anterolateral intercostal thoracotomy. Thereafter, wound infection persisted for 3 years with formation of cutaneous fistulae and granulation tissue. Chest computed tomography revealed osteolysis, swollen ribs and costal cartilage, and cutaneous fistulous tracts. Bone scintigraphy with 99mTechnetium revealed abnormal accumulation in the ribs and costal cartilage, indicating costochondritis and osteomyelitis of ribs with cutaneous fistulae. Surgical resection of the skin including the cutaneous fistulae, infected ribs and costal cartilage were performed successfully.