Trans-sternal thoracotomy - normal postoperative appearance

Case contributed by Dr René Pfleger

Presentation

S/p median sternotomy 3 days before. Focal erythema and serous discharge at surgical site. No fever or increased leukocyte count. Sternal instability at clinical examination.

Patient Data

Age: 70 years
Gender: Male

Status post median sternotomy with normal postoperative findings including sternum with only minimal step-offs and a localized retrosternal fluid collection with a distinct margin. The majority of the mediastinal fat planes are preserved. There are no fluid collections or gas bubbles deep within the incision in the presternal soft-tissues.

Volume-rendered CT shows sternum without gaps.

3D volume-rendered CT depicts sternum with only minimal step-offs. There is no displacement, rotation or fracture of the sternotomy wires.

Sagittal MPR CT shows a medium-sized sharply marginated retrosternal fluid collection (red arrow). The complex fluid contains small foci of fat (yellow arrow). The majority of the mediastinal fat is preserved (green arrow).

Case Discussion

Bacterial wound culture obtained from incision site: No growth of any pathogenic organism. Vacuum assisted closure of the superficial sternal wound was applied and the patient made an uneventful recovery.

Key points:

  • median sternotomy, the most commonly used incision for open cardiac surgery, carries a 0.5-5% risk of serious complications
  • sternal dehiscence is a common precursor to deep sternal wound infection (mediastinitis)
  • CT is the modality of choice in evaluation of complications after sternotomy

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