Poststernotomy Imaging: Pictorial Review of Expected Postsurgical Findings and Complications

References

• 1. Maier RH, Kasim AS, Zacharias J, et al. Minimally invasive versus conventional sternotomy for mitral valve repair: protocol for a multicentre randomised controlled trial (UK Mini Mitral). BMJ Open 2021;11(4):e047676.
  Medline Google Scholar
• 2. Kayatta MO, Halkos ME, Narayan P. Minimally invasive coronary artery bypass grafting. Indian J Thorac Cardiovasc Surg 2018;34(suppl 3):302–309.
  Medline Google Scholar
• 3. Berretta P, Galeazzi M, Cefarelli M, et al. Minimally invasive approach: is this the future of aortic surgery? Indian J Thorac Cardiovasc Surg 2022;38(suppl 1):171–182.
  Medline Google Scholar
• 4. Tabata M, Khalpey Z, Aranki SF, Couper GS, Cohn LH, Shekar PS. Minimal access surgery of ascending and proximal arch of the aorta: a 9-year experience. Ann Thorac Surg 2007;84(1):67–72.
  Medline Google Scholar
• 5. Shudo Y, Rinewalt D, Lingala B, et al. Impact of Surgical Approach in Double Lung Transplantation: Median Sternotomy vs Clamshell Thoracotomy. Transplant Proc 2020;52(1):321–325.
  Medline Google Scholar
• 6. Young A, Goga U, Aktuerk D, Aziz Z, Cross S, Balan A. A radiologist’s guide to median sternotomy. Clin Radiol 2024;79(1):33–40.
  Medline Google Scholar
• 7. Wu Y, Jiang W, Li D, et al. Surgery of ascending aorta with complex procedures for aortic dissection through upper mini-sternotomy versus conventional sternotomy. J Cardiothorac Surg 2020;15(1):57.
  Medline Google Scholar
• 8. Hota P, Dass C, Erkmen C, Donuru A, Kumaran M. Poststernotomy Complications: A Multimodal Review of Normal and Abnormal Postoperative Imaging Findings. AJR Am J Roentgenol 2018;211(6):1194–1205.
  Medline Google Scholar
• 9. Stark P, Jaramillo D. CT of the sternum. AJR Am J Roentgenol 1986;147(1):72–77.
  Medline Google Scholar
• 10. Alhalawani AM, Towler MR. A review of sternal closure techniques. J Biomater Appl 2013;28(4):483–497.
  Medline Google Scholar
• 11. Restrepo CS, Martinez S, Lemos DF, et al. Imaging Appearances of the Sternum and Sternoclavicular Joints. RadioGraphics 2009;29(3):839–859.
  Google Scholar
• 12. Median sternotomy. Multimedia Manual of Cardio-Thoracic Surgery. https://mmcts.org/tutorial/80. Accessed January 17, 2024.
  Google Scholar
• 13. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021;143(5):e35–e71. [Published corrections appear in Circulation 2021;143(5):e228 and Circulation 2021;143(10):e784.]
  Medline Google Scholar
• 14. Paul S, Lee PC, Altorki NK, Stiles BM, Port JL. Partial upper sternotomy for anterosuperior mediastinal surgery: an institutional experience. Ann Surg Oncol 2009;16(4):1039–1042.
  Medline Google Scholar
• 15. Randecker H. Median Sternotomy Closure: A Simple Inexpensive Effective Technique. Ann Thorac Surg 2005;80(6):2393–2394.
  Medline Google Scholar
• 16. Cataneo DC, Dos Reis TA, Felisberto G Jr, Rodrigues OR, Cataneo AJM. New sternal closure methods versus the standard closure method: systematic review and meta-analysis. Interact Cardiovasc Thorac Surg 2019;28(3):432–440.
  Medline Google Scholar
• 17. Wang B, He D, Wang M, et al. Analysis of sternal healing after median sternotomy in low risk patients at midterm follow-up: retrospective cohort study from two centres. J Cardiothorac Surg 2019;14(1):193.
  Medline Google Scholar
• 18. Sharma R, Puri D, Panigrahi BP, Virdi IS. A modified parasternal wire technique for prevention and treatment of sternal dehiscence. Ann Thorac Surg 2004;77(1):210–213.
  Medline Google Scholar
• 19. Dell’Amore A, Campisi A, Giunta D, et al. Surgical options to treat massive sternal defect after failed Robicsek procedure. J Thorac Dis 2018;10(6):E410–E415.
  Medline Google Scholar
• 20. Elghonemy YF, Hussein MA. Titanium plate fixation versus wire sternal closure in coronary artery bypass graft patients: need for rigid sternal fixation. J Egypt Soc Cardio-Thorac Surg [Internet] 2016;24(2):150–158.
  Google Scholar
• 21. Elgharably H, Javorski MJ, McCurry KR. Bilateral sequential lung transplantation: technical aspects. J Thorac Dis 2021;13(11):6564–6575.
  Medline Google Scholar
• 22. Mody GN, Coppolino A, Singh SK, Mallidi HR. Sternotomy versus thoracotomy lung transplantation: key tips and contemporary results. Ann Cardiothorac Surg 2020;9(1):60–64.
  Medline Google Scholar
• 23. Paulich S, Lockey D. Resuscitative thoracotomy. BJA Educ 2020;20(7):242–248.
  Medline Google Scholar
• 24. Coster JN, Chan EG, Furukawa M, Sanchez PG. Experience using a flexible reinforced fiber suture for sternal closure in bilateral lung transplantation recipients undergoing bilateral transverse thoracosternotomy. JTCVS Tech 2022;14:168–170.
  Medline Google Scholar
• 25. Song Y, Chu W, Sun J, et al. Review on risk factors, classification, and treatment of sternal wound infection. J Cardiothorac Surg 2023;18(1):184.
  Medline Google Scholar
• 26. Molina JE, Lew RS-L, Hyland KJ. Postoperative sternal dehiscence in obese patients: incidence and prevention. Ann Thorac Surg 2004;78(3):912–917; discussion 912–917.
  Medline Google Scholar
• 27. Chepla KJ, Salgado CJ, Tang CJ, Mardini S, Evans KK. Late complications of chest wall reconstruction: management of painful sternal nonunion. Semin Plast Surg 2011;25(1):98–106.
  Medline Google Scholar
• 28. Li AE, Fishman EK. Evaluation of Complications after Sternotomy Using Single- and Multidetector CT with Three-dimensional Volume Rendering. AJR Am J Roentgenol 2003;181(4):1065–1070.
  Medline Google Scholar
• 29. Heilmann C, Stahl R, Schneider C, et al. Wound complications after median sternotomy: a single-centre study. Interact Cardiovasc Thorac Surg 2013;16(5):643–648.
  Medline Google Scholar
• 30. Ridderstolpe L, Gill H, Granfeldt H, Ahlfeldt H, Rutberg H. Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg 2001;20(6):1168–1175.
  Medline Google Scholar
• 31. Carter AR, Sostman HD, Curtis AM, Swett HA. Thoracic alterations after cardiac surgery. AJR Am J Roentgenol 1983;140(3):475–481.
  Medline Google Scholar
• 32. Karthik S, Grayson AD, McCarron EE, Pullan DM, Desmond MJ. Reexploration for bleeding after coronary artery bypass surgery: risk factors, outcomes, and the effect of time delay. Ann Thorac Surg 2004;78(2):527–534; discussion 534.
  Medline Google Scholar
• 33. Lu JCY, Grayson AD, Jha P, Srinivasan AK, Fabri BM. Risk factors for sternal wound infection and mid-term survival following coronary artery bypass surgery. Eur J Cardiothorac Surg 2003;23(6):943–949.
  Medline Google Scholar
• 34. Kunisawa S, Kosaka S, Matsukura T, et al. Chronic Expanding Hematoma in Sternum Resected 5 Years after Median Sternotomy. Ann Thorac Surg 2008;85(4):1447–1448.
  Medline Google Scholar
• 35. Schimmer C, Reents W, Berneder S, et al. Prevention of sternal dehiscence and infection in high-risk patients: a prospective randomized multicenter trial. Ann Thorac Surg 2008;86(6):1897–1904.
  Medline Google Scholar
• 36. Shih CC, Shih CM, Su YY, Lin SJ. Potential risk of sternal wires. Eur J Cardiothorac Surg 2004;25(5):812–818.
  Medline Google Scholar
• 37. Boiselle PM, Mansilla AV, Fisher MS, McLoud TC. Wandering wires: frequency of sternal wire abnormalities in patients with sternal dehiscence. AJR Am J Roentgenol 1999;173(3):777–780.
  Medline Google Scholar
• 38. Gad MM, Gupta A. Dancing sternal wires: a radiologic sign of sternal dehiscence. Cleve Clin J Med 2019;86(2):87–88.
  Medline Google Scholar
• 39. Singh K, Anderson E, Harper JG. Overview and Management of Sternal Wound Infection. Semin Plast Surg 2011;25(1):25–33.
  Medline Google Scholar
• 40. van Wingerden JJ, Ubbink DT, van der Horst CM, de Mol BA. Poststernotomy mediastinitis: a classification to initiate and evaluate reconstructive management based on evidence from a structured review. J Cardiothorac Surg 2014;9(1):179.
  Medline Google Scholar
• 41. Braxton JH, Marrin CAS, McGrath PD, et al. 10-year follow-up of patients with and without mediastinitis. Semin Thorac Cardiovasc Surg 2004;16(1):70–76.
  Medline Google Scholar
• 42. Kaul P. Sternal reconstruction after post-sternotomy mediastinitis. J Cardiothorac Surg 2017;12(1):94.
  Medline Google Scholar
• 43. Buğra AK, Göde S, Buğra A, et al. Mediastinitis after cardiac surgery: risk factors and our vacuum-assisted closure results. Kardiochir Torakochirurgia Pol 2021;18(4):195–202.
  Medline Google Scholar
• 44. Yu WK, Chen YW, Shie HG, Lien TC, Kao HK, Wang JH. Hyperbaric oxygen therapy as an adjunctive treatment for sternal infection and osteomyelitis after sternotomy and cardiothoracic surgery. J Cardiothorac Surg 2011;6(1):141.
  Medline Google Scholar
• 45. Mens MA, de Geus A, Wellenberg RHH, et al. Preliminary evaluation of dual-energy CT to quantitatively assess bone marrow edema in patients with diabetic foot ulcers and suspected osteomyelitis. Eur Radiol 2023;33(8):5645–5652.
  Medline Google Scholar
• 46. Lee YJ, Sadigh S, Mankad K, Kapse N, Rajeswaran G. The imaging of osteomyelitis. Quant Imaging Med Surg 2016;6(2):184–198.
  Medline Google Scholar
• 47. Pineda C, Espinosa R, Pena A. Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy. Semin Plast Surg 2009;23(2):80–89.
  Medline Google Scholar
• 48. Hulsen DJW, Mitea C, Arts JJ, Loeffen D, Geurts J. Diagnostic value of hybrid FDG-PET/MR imaging of chronic osteomyelitis. Eur J Hybrid Imaging 2022;6(1):15.
  Medline Google Scholar
• 49. Hariri H, Tan S, Martineau P, et al. Utility of FDG-PET/CT for the Detection and Characterization of Sternal Wound Infection Following Sternotomy. Nucl Med Mol Imaging 2019;53(4):253–262.
  Medline Google Scholar
• 50. Shanmuga P, Subramanyam P. 99mTc MDP and 67Gallium Dual Isotope Imaging in the Evaluation of Sternal Osteomyelitis and Wound Dehiscence. J Nucl Med Radiat Ther 2015;06(06):1000266.
  Google Scholar
• 51. Tocco MP, Ballardini M, Masala M, Perozzi A. Post-sternotomy chronic osteomyelitis: is sternal resection always necessary? Eur J Cardiothorac Surg 2013;43(4):715–721.
  Medline Google Scholar
• 52. Elmistekawy E, Attia A. Chronic post sternotomy pain: the role of sternal wire removal—a review. https://amj.amegroups.org/article/view/5558. Published 2020. Accessed February 7, 2024.
  Google Scholar
• 53. Eraqi M, Diab AH, Matschke K, Alexiou K. Confirmation of Safety of Titanium Wire in Sternotomy Closure, A Randomized Prospective Study. Thorac Cardiovasc Surg 2024;72(1):70–76.
  Medline Google Scholar
• 54. Khouzam MS, Jacobsen K, Boyer JH, et al. Fractured sternal wire causing a cardiac laceration. J Cardiothorac Surg 2023;18(1):358.
  Medline Google Scholar
• 55. O’Brien DJ, Baghaffar A, El-Andari R, DiQuinzio C, Ali IM. Right ventricular laceration caused by sternal wire fracture following cardiac surgery: a case report. Indian J Thorac Cardiovasc Surg 2022;38(4):418–421.
  Medline Google Scholar
• 56. Deutsch M-A, Noebauer C, Seyfarth M, et al. Unexpected Cause for Chest Pain. Circulation 2010;122(18):e502–e505.
  Medline Google Scholar
• 57. Imran Hamid U, Gillespie S, Lynchehaun C, Parissis H. Traumatic Bilateral Pneumothoraces due to Sternal Wire Migration. Case Rep Med 2012;2012:438429.
  Medline Google Scholar
• 58. Abdul Ghani OA, Lau J, Kemble A. A runaway sternal wire: a rare case and outcome of sternal wire intravascular embolization. J Cardiol Cases 2016;14(4):100–102.
  Medline Google Scholar
• 59. Ethier T, Bisleri G, Ribeiro IB, Payne D. Surgical Removal of Migrated Broken Sternal Wire Using Endoscopic Assistance. Ann Thorac Surg 2020;109(2):e107–e108.
  Medline Google Scholar
• 60. Bitkover CY, Cederlund K, Aberg B, Vaage J. Computed tomography of the sternum and mediastinum after median sternotomy. Ann Thorac Surg 1999;68(3):858–863.
  Medline Google Scholar
• 61. Chan J, O’Hanlon J, McKenna J, Oo S. Subxiphoid incisional hernias post median sternotomy: a literature review. J Card Surg 2021;36(3):1050–1055.
  Medline Google Scholar
• 62. Agolia JP, Forrester JD. Subxiphoid hernia and sternal nonunion. Trauma Surg Acute Care Open 2023;8(1):e001162.
  Medline Google Scholar
• 63. Wyckman A, Abdelrahman I, Steinvall I, et al. Reconstruction of sternal defects after sternotomy with postoperative osteomyelitis, using a unilateral pectoralis major advancement muscle flap [Internet]. Sci Rep 2020;10(1):8380.
  Medline Google Scholar
• 64. Lall C, Tirkes TA, Patel AA, et al. Flaps, Slings, and Other Things: CT after Reconstructive Surgery—Expected Changes and Detection of Complications. AJR Am J Roentgenol 2012;198(6):W521–W533.
  Medline Google Scholar
• 65. Hachiro Y, Kikuchi S, Ito M, Takahashi K, Abe T. Infection of a retained permanent epicardial pacemaker lead. Ann Thorac Surg 2001;71(6):2038–2039.
  Medline Google Scholar
• 66. Choo MH, Holmes DR Jr, Gersh BJ, et al. Infected epicardial pacemaker systems: partial versus total removal. J Thorac Cardiovasc Surg 1981;82(5):794–796.
  Medline Google Scholar
• 67. Gumbs RV, Peniston RL, Nabhani HA, Henry LJ. Rib fractures complicating median sternotomy. Ann Thorac Surg 1991;51(6):952–955.
  Medline Google Scholar
• 68. Valente T, Bocchini G, Rossi G, Sica G, Davison H, Scaglione M. MDCT prior to median re-sternotomy in cardiovascular surgery: our experiences, infrequent findings and the crucial role of radiological report. Br J Radiol 2019;92(1101):20170980.
  Medline Google Scholar
• 69. Norton EL, Kalra K, Leshnower BG, Wei JW, Binongo JN, Chen EP. Redo aortic surgery: does one versus multiple affect outcomes? JTCVS Open 2023;16:158–166.
  Medline Google Scholar
• 70. Elahi M, Dhannapuneni R, Firmin R, Hickey M. Direct complications of repeat median sternotomy in adults. Asian Cardiovasc Thorac Ann 2005;13(2):135–138.
  Medline Google Scholar
• 71. Cremer J, Teebken OE, Simon A, Hutzelmann A, Heller M, Haverich A. Thoracic computed tomography prior to redo coronary surgery. Eur J Cardiothorac Surg 1998;13(6):650–654.
  Medline Google Scholar
• 72. Gilkeson RC, Markowitz AH, Ciancibello L. Multisection CT Evaluation of the Reoperative Cardiac Surgery Patient. RadioGraphics 2003;23 Spec No:S3–S17.
  Google Scholar
• 73. Imran Hamid U, Digney R, Soo L, Leung S, Graham ANJ. Incidence and outcome of re-entry injury in redo cardiac surgery: benefits of preoperative planning. Eur J Cardiothorac Surg 2015;47(5):819–823.
  Medline Google Scholar
• 74. Shann KG, Likosky DS, Murkin JM, et al. An evidence-based review of the practice of cardiopulmonary bypass in adults: a focus on neurologic injury, glycemic control, hemodilution, and the inflammatory response. J Thorac Cardiovasc Surg 2006;132(2):283–290.
  Medline Google Scholar
• 75. Mizuno T, Toyama M, Tabuchi N, et al. Thickened intima of the aortic arch is a risk factor for stroke with coronary artery bypass grafting. Ann Thorac Surg 2000;70(5):1565–1570.
  Medline Google Scholar