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"Missing" Sternal Ossification Center: Potential Mimicker of Disease in Young Children¹

¹ From the Departments of Radiology (W.J.R., L.F.D., A.S.B., C.G.A.) and Pediatrics (L.F.D., A.S.B., C.G.A., S.A.P.), Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039. Received July 16, 2001; revision requested September 10; revision received November 15; accepted January 8, 2002. Address correspondence to L.F.D. (e-mail: Lane.donnelly@chmcc.org).

View larger version (76K): [in a new window]   Figure 1a. Radiographs obtained because of cough in a 2-year-old boy show missing sternal ossification center. (a) Lateral radiograph shows markedly decreased ossification of sternal segment 2 (arrows). The absence of ossification and the absence of soft-tissue prominence in the region were interpreted as suggestive of a destructive process. Numbers denote sternal segments. The region of sternal segment 5 (arrowhead) is also nonossified. Findings of a radiographic skeletal survey were otherwise normal. 1, 3, and 4 = sternal segments 1, 3, and 4. (b) Sagittal fast spin-echo magnetic resonance (MR) image (repetitition time msec/echo time msec, 3,000/15) with intermediate weighting shows no abnormality in the region of sternal segment 2 (arrows). (c) Sagittal fast spin-echo MR image (3,000/80) with T2 weighting shows high signal intensity in ossified sternal segments 1, 3, and 4. Sternal segments 2 (arrows) and 5 (arrowheads) demonstrate low signal intensity, which is consistent with asynchronous ossification.

View larger version (89K): [in a new window]   Figure 1b. Radiographs obtained because of cough in a 2-year-old boy show missing sternal ossification center. (a) Lateral radiograph shows markedly decreased ossification of sternal segment 2 (arrows). The absence of ossification and the absence of soft-tissue prominence in the region were interpreted as suggestive of a destructive process. Numbers denote sternal segments. The region of sternal segment 5 (arrowhead) is also nonossified. Findings of a radiographic skeletal survey were otherwise normal. 1, 3, and 4 = sternal segments 1, 3, and 4. (b) Sagittal fast spin-echo magnetic resonance (MR) image (repetitition time msec/echo time msec, 3,000/15) with intermediate weighting shows no abnormality in the region of sternal segment 2 (arrows). (c) Sagittal fast spin-echo MR image (3,000/80) with T2 weighting shows high signal intensity in ossified sternal segments 1, 3, and 4. Sternal segments 2 (arrows) and 5 (arrowheads) demonstrate low signal intensity, which is consistent with asynchronous ossification.

View larger version (97K): [in a new window]   Figure 1c. Radiographs obtained because of cough in a 2-year-old boy show missing sternal ossification center. (a) Lateral radiograph shows markedly decreased ossification of sternal segment 2 (arrows). The absence of ossification and the absence of soft-tissue prominence in the region were interpreted as suggestive of a destructive process. Numbers denote sternal segments. The region of sternal segment 5 (arrowhead) is also nonossified. Findings of a radiographic skeletal survey were otherwise normal. 1, 3, and 4 = sternal segments 1, 3, and 4. (b) Sagittal fast spin-echo magnetic resonance (MR) image (repetitition time msec/echo time msec, 3,000/15) with intermediate weighting shows no abnormality in the region of sternal segment 2 (arrows). (c) Sagittal fast spin-echo MR image (3,000/80) with T2 weighting shows high signal intensity in ossified sternal segments 1, 3, and 4. Sternal segments 2 (arrows) and 5 (arrowheads) demonstrate low signal intensity, which is consistent with asynchronous ossification.

View larger version (79K): [in a new window]   Figure 2. Lateral radiograph obtained in a 1-year-old boy shows nonossification of sternal segment 2 (2). Sternal segments 1, 3, 4, and 5 (1, 3, 4, and 5) are ossified.

View larger version (59K): [in a new window]   Figure 3. Lateral radiograph obtained in a 10-month-old girl shows lack of ossification of sternal segment 5. Sternal segments 1-4 (1-4) are ossified.

View larger version (74K): [in a new window]   Figure 4. Lateral radiograph shows lack of ossification of sternal segments 2, 4, and 5 (arrows) in a 1-year-old girl. Sternal segments 1 (1) and 3 (3) are ossified.