A 69-year-old male patient, who has suffered from variant angina for 6 years, presented with persistent chest pain despite maximal pharmacological treatment. The chest pain was continuous and aggravated intermittently. He denied history of dyspnea on exertion or chest pain during exercise. Physical examination on chest was grossly nonspecific. To exclude non-cardiac causes of chest pain, SPECT/CT was performed and active arthritis of sternal angle was demonstrated. We successfully treated the arthritis with intra-articular injection of steroid with improvement of continuous pain.

Keywordsrefractory angina, SPECT/CT, osteoarthritis, manubriosternal joint.