US Chest US is a useful modality for targeted evaluation of soft tissue, osseous, and joints of the chest wall and for characterization and potential drainage of abscesses and joint effusions but has limited capability of determining extent of disease [48]. Variant 4: Nontraumatic chest wall pain. History of prior chest intervention. Secondary evaluation after normal chest radiograph. Next imaging study. Bone Scan Whole Body A single case report described bone scan findings of heterogeneous radiotracer uptake in ribs that were within the areas of the chest wall that received >30 Gy after a chest CT revealed no abnormality [62]. In a case report of a patient with chest pain 11 months after chest wall radiation for breast cancer, a bone scan showed evidence of costochondritis but no metastases after initial negative CT and were both later positive after the patient developed rib fractures [63]. Bone scan or radiolabeled WBC scan plays a role in the evaluation of sternal osteomyelitis, especially in patients who have equivocal CT findings, maintaining a high negative predictive value for osteomyelitis [64]. CT has variable performance in the diagnosis of sternal wound infections after cardiac surgery. Most patients may present with clinical signs and symptoms of sternal infection, precluding the need for imaging. However, CT may be useful for diagnosis in patients in whom the diagnosis is suspected but who lack overt clinical signs and symptoms [64,67]. In a study of 40 patients, the sensitivity and specificity of CT for diagnosis of mediastinitis was best beyond 17 days after surgery (100% and 90%, respectively), with 100% sensitivity and only 33% specificity in the first 17 postoperative days [68,69]. Noninfectious poststernotomy chest pain may affect more than half of patients after sternotomy and was inversely correlated with the degree of osseous healing (complete versus incomplete) [8].
Nontraumatic Chest Wall Pain. US Chest US is a useful modality for targeted evaluation of soft tissue, osseous, and joints of the chest wall and for characterization and potential drainage of abscesses and joint effusions but has limited capability of determining extent of disease [48]. Variant 4: Nontraumatic chest wall pain. History of prior chest intervention. Secondary evaluation after normal chest radiograph. Next imaging study. Bone Scan Whole Body A single case report described bone scan findings of heterogeneous radiotracer uptake in ribs that were within the areas of the chest wall that received >30 Gy after a chest CT revealed no abnormality [62]. In a case report of a patient with chest pain 11 months after chest wall radiation for breast cancer, a bone scan showed evidence of costochondritis but no metastases after initial negative CT and were both later positive after the patient developed rib fractures [63]. Bone scan or radiolabeled WBC scan plays a role in the evaluation of sternal osteomyelitis, especially in patients who have equivocal CT findings, maintaining a high negative predictive value for osteomyelitis [64]. CT has variable performance in the diagnosis of sternal wound infections after cardiac surgery. Most patients may present with clinical signs and symptoms of sternal infection, precluding the need for imaging. However, CT may be useful for diagnosis in patients in whom the diagnosis is suspected but who lack overt clinical signs and symptoms [64,67]. In a study of 40 patients, the sensitivity and specificity of CT for diagnosis of mediastinitis was best beyond 17 days after surgery (100% and 90%, respectively), with 100% sensitivity and only 33% specificity in the first 17 postoperative days [68,69]. Noninfectious poststernotomy chest pain may affect more than half of patients after sternotomy and was inversely correlated with the degree of osseous healing (complete versus incomplete) [8].