In 1930 Higoumenakis1 described as a new sign of late prenatal syphilis the enlargement and anteroposterior thickening of the sternal end of the clavicle. This enlargement is usually unilateral and is present on the right side, except in left-handed persons, in whom it occurs on the left side. The sign is revealed by inspection and palpation and frequently by roentgenograms—in the latter as an exostosis of the sternal end of the clavicle. Higoumenakis explained the development of the exostosis on the basis of three factors, namely, anatomic, biologic and mechanical. It is known that the sternal end of the clavicle first consists of connective tissue which is early transformed into osseous tissue. Spirochaeta pallida, which is carried in the blood stream of the fetus, becomes as readily localized in the connective tissues as in the lymphatic spaces and in other organs of the fetus. The organisms may
DORNE M, ZAKON SJ. ENLARGEMENT OF ONE STERNOCLAVICULAR ARTICULATION AS A VALUABLE CLINICAL SIGN OF LATE PRENATAL (CONGENITAL) SYPHILIS. Arch Derm Syphilol. 1935;32(4):602–604. doi:10.1001/archderm.1935.01470040059011
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