OBJECTIVE: To describe the clinical, imaging and pathological findings of SAPHO syndrome and to point out that although considered rare this syndrome may be under-diagnosed by clinicians and radiologists, probably due to unfamiliarity with its features. MATERIALS AND METHODS: A retrospective study of six cases diagnosed in the last six years, with emphasis on clinical findings (age, sex and symptoms) and imaging findings (bone scintigraphy, conventional x-ray, computed tomography and magnetic resonance imaging) was conducted. RESULTS: The initial clinical presentation in all patients was pain in the upper anterior chest wall for at least four months. Imaging findings of all these patients indicated inflammatory process and/or hyperostosis and osteitis in the joints of the upper anterior chest wall. Skin manifestations of the syndrome, such as palmoplantar pustulosis, were identified in five of the patients. In none of the cases the diagnosis was suggested either at the initial clinical medical appointment or after imaging assessment by radiologists not specialized in musculoskeletal system. CONCLUSION: Our clinical and imaging findings are in line with the ones described in the literature. This diagnosis must be considered for each patient presenting with pain in the upper anterior chest wall associated with skin lesions and/or osteitis.

Keywords: Acquired hyperostosis syndrome, Sternocostoclavicular hyperostosis, Psoriasis, Osteitis