Imaging for Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome

UMMS Affiliation

Department of Medicine, Division of Rheumatology; Department of Radiology

Publication Date


Document Type



Dermatology | Radiology | Rheumatology


Multifocal osteomyelitis and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome constitute a spectrum of disease that includes inflammatory bone lesions and dermatologic findings. Radiographic features resemble those of the spondyloarthropathies with anterior chest wall involvement. Early radiographic findings are osteodestructive with lytic lesions. Bone scintigraphy of the sternoclavicular region classically yields a 'bull's head' pattern of radionuclide uptake. Magnetic resonance imaging (MRI) can demonstrate corner lesions of vertebral bodies. Ultrasound often reveals peripheral enthesitis. Late radiographic features are usually osteoproliferative. PET/CT can identify chronic lesions. Differential diagnostic considerations include osteomyelitis and malignancy, which often prompt bone biopsy.


Acne, CRMO, Hyperostosis, Osteitis, Palmoplantar pustulosis, SAPHO syndrome, Vertebral corner lesion, ‘Bull's head’ sign

Rights and Permissions

Citation: Rheum Dis Clin North Am. 2016 Nov;42(4):695-710. doi: 10.1016/j.rdc.2016.07.011. Link to article on publisher's site

Journal/Book/Conference Title

Rheumatic diseases clinics of North America

Related Resources

Link to Article in PubMed

PubMed ID