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Case report
Emphysematous osteomyelitis of the clavicle: a pleural process?
  1. Amira Elshikh1,
  2. Niraj Gowda1,
  3. Lisa Glass2 and
  4. Robert B Maximos3,4
  1. 1Internal Medicine, George Washington University, Washington, District of Columbia, USA
  2. 2Division of Pulmonary, Critical Care and Sleep Disorders Medicine, Department of Medicine, George Washington University, Washington, District of Columbia, USA
  3. 3Pulmonary, Critical Care and Sleep Disorders Medicine, The George Washington University Hospital, Washington, District of Columbia, USA
  4. 4Pulmonary and Critical Care, Department of Veterans Affairs, Washington, District of Columbia, USA
  1. Correspondence to Dr Amira Elshikh; aelshikh43{at}


Emphysematous osteomyelitis (EO) is a rare infection associated with intraosseous gas. EO is an often fatal disease with an estimated 34% mortality. We present a case of a 63-year-old man with sternoclavicular EO with pleural involvement and significant subcutaneous emphysema diagnosed by CT. Extension of intraosseous gas into the pleural cavity is an extremely interesting presentation that has not been previously reported. The patient underwent a multidisciplinary treatment approach with surgical debridement and an extended antibiotic course. Intraoperative cultures of the pectoralis muscle and bone biopsy grew pan-sensitive Escherichia coli. Prompt recognition and treatment are paramount to avoid a potentially fatal outcome. A review of the literature of the previous 46 cases of EO is presented for associated risk factors, the role of surgical management and antibiotic therapy.

  • bone and joint infections
  • adult intensive care
  • medical management
  • radiology

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  • Contributors All authors made substantial contributions to this case presentation. AE and NG started the first draft and LG and RBM revised it critically for intellectual content. AE and NG collected data from prior case reports and interpreted the trends, which were confirmed by LG and RBM. All authors have read and approved the final draft and agree to be held accountable for all aspects of this report and its integrity.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.