Primary Sternal Osteomyelitis or Sternal Pseudotumor of Childhood: A Case Series and Review of the Literature

BACKGROUND: Primary sternal osteomyelitis (PSO) in children is a rare condition with less than 100 cases described in the literature. Sternal pseudotumors and Self Limiting Sternal Tumor of Childhood (SELSTOC) as a different entity seem to have similar clinical findings but a completely different approach to treatment. METHODS: We analyze a case series of 5 cases of PSO and review the literature to compare PSO and SELSTOC. RESULTS: Main symptoms of PSO and SELSTOC involve presternal swelling (90% vs. 100%), pain (70% vs. 58%), erythema (47% vs. 27%) and fever (60% vs. 21%). The most reliable laboratory marker is erythrocyte sedimentation rate (96% vs. 100% positive), followed by C-reactive protein (89% vs. 65% positive) and white blood cell count (64% v.s 45% elevated). A pathogen could be isolated in 88% of PSO cases, whereas only in 6% of SELSTOC cases. While intervention or surgery rates were similar (58% vs. 38%), treatment with antibiotics differed significantly (100% vs. 33%). CONCLUSIONS: Considering the similarities in clinical and radiologic features, SELSTOC might be a phenotype of PSO rather than a separate entity. Improved pathogen detection may help clarify its relationship to PSO and guide appropriate management strategies, particularly to avoid unnecessary treatment in benign cases of PSO.