# Non-Traumatic Clavicular Lesions in Children: Case Series and Literature Review

## TL;DR

This study examines non-traumatic clavicular issues in children, finding chronic nonbacterial osteomyelitis as the most common cause.

## Contribution

The study provides a detailed case series and literature review on rare pediatric clavicular conditions.

## Key findings

- Chronic nonbacterial osteomyelitis (CNO) was the most frequent diagnosis in 8 out of 12 cases.
- Biopsy was often needed to rule out malignancy and clarify atypical presentations.
- Multifocal lesions were found in 6 out of 8 CNO patients via whole-body MRI.

## Abstract

Background and Objective: Clavicular pain and swelling in children can have multiple causes and often require a multidisciplinary approach. We aimed to describe the characteristics and final diagnoses of children with clavicular involvement and to review the literature on this topic. Methods: We retrospectively reviewed patients younger than 18 years who were evaluated for clavicular symptoms at two pediatric rheumatology centers and one pediatric oncohematology center. These data were then descriptively compared with findings from 63 patients reported across 7 published articles. Results: Twelve patients (9 females, median age 10 years [IQR 9.4–10.5]) were included. Final diagnoses were chronic nonbacterial osteomyelitis (CNO; 8), Langerhans cell histiocytosis (LCH; 2), reactive arthritis (1), and Tietze syndrome (1). Clavicular involvement was mostly unilateral and localized to the medial clavicle in CNO. The most frequent presenting symptom was local swelling (11/12), followed by pain (9/12). Diagnostic delay was a median of 4 months (IQR 1–10.5). Whole-body MRI revealed multifocal lesions in 6/8 CNO patients. Biopsy was often required for diagnosis primarily to exclude malignancy and to clarify atypical or unifocal presentations. The literature review confirmed CNO as the most frequent cause, followed by rare tumors. Conclusions: CNO predominates among pediatric non-traumatic clavicular lesions, but LCH and rare conditions are not uncommon, underscoring the need for careful differential diagnosis and targeted imaging.