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Musculoskeletal and Sports Medicine

Sternoclavicular Pain as Presenting Symptom of Urothelial Carcinoma: A Case Report

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 2

    Primary Author(s)

  • Gloria Coden, MD

    PGY-2
    Washington University/B-JH/SLCH Consortium PM&R Program
    Saint Louis, Missouri

    • Co-Author(s)

  • JM

    John Metzler, MD

    Professor
    Washington University/B-JH/SLCH Consortium PM&R Program
    Saint Louis, Missouri

Disclosure(s):
Gloria Coden, MD: No financial relationships to disclose
Case Diagnosis: 48-year-old male who presented with sternoclavicular and chest pain, which was found due to be due to metastasis to the sternum and manubrium as the presenting symptom of undiagnosed urothelial carcinoma.

Case Description or Program Description: 48-year-old male with a past medical history of a cerebrovascular accident and vertebral artery dissection who presented with 3 months of sternoclavicular and chest pain. The pain started after the patient performed repetitive movements while aerating his yard. The pain had significantly worsened over the next 3 months and the patient developed swelling over the sternum. Physical exam demonstrated swelling and tenderness to palpation over the bilateral sternoclavicular joints and some tenderness to palpation over the costochondral joints. There was pain with crossed adduction. Bilateral shoulder range of motion was full and painless.

Setting: Outpatient physical medicine and rehabilitation office at an academic medical center

Assessment/Results: Chest radiographs demonstrated no obvious bony abnormality. Computed tomographic of the chest demonstrated a lesion involving the entire manubrium and upper half of the sternum with extensive osseous destruction and surrounding extraosseous soft tissue component. Additional imaging and pathology revealed the mass to be a solitary metastasis of stage IV high-grade urothelial carcinoma with squamous cell features of the bladder with a FGFR3-Y373C mutation. Patient was successfully treated with pembrolizumab, enfortumab, zoledronic acid, radiation to the sternum, and resection of the bladder mass with complete resolution of the sternal mass and symptoms.

Discussion (relevance): Sternoclavicular pain has a broad differential, including costochondritis, arthritis, fracture, sprain, muscle strain, dislocation, infectious etiology, and inflammatory etiologies. This case illustrates the importance of obtaining an accurate diagnosis using advanced imaging, even though this patient had a known mechanism of injury and normal radiographs.

Conclusions: Accurate diagnosis of sternoclavicular pain is crucial to provide appropriate treatment and exclude malicious etiologies.