A 62-year-old man with a history of coronary artery disease (CAD) and coronary artery bypass graft (CABG) surgery presented to the emergency department with anterior chest pain and shortness of breath. A computed tomographic (CT) scan of the chest was obtained.
Brendan P. Coleman, MD,
Department of Radiology, Saint Vincent's Medical Center,
A 62-year-old man with a history of coronary artery disease
(CAD) and coronary artery bypass graft (CABG) surgery presented to
the emergency department with anterior chest pain and shortness of
breath. A computed tomographic (CT) scan of the chest was
Routine frontal chest radiographs commonly show abnormal
alignment to the sternotomy wires in patients with sternal
dehiscence that is also visable on the frontal scout CT film
obtained while the patient was undergoing CT imaging (Figure 1).
The exact location of the sternotomy wires as well as improved
soft-tissue resolution were noted on the axial CT images (Figure
2). The axial images also provide detail regarding possible bone
destruction, abcess formation, or subcutaneous emphysema.
Sternal dehiscence is an uncommon complication of median
sternotomy occurring in approximately 3% to 5% of patients.
It is potentially fatal and can be a difficult diagnosis
clinically. Risk factors include prolonged ventilator support,
blood loss requiring transfusion, postoperative wound infection,
obesity, age, chronic obstructive pulmonary disease (COPD), and
This complication usually occurs during the initial hospital
The diagnosis is made radiographically in most cases. Plain
X-ray of the sternum will most commonly reveal sternal wire
abnormalities. Displacement of one or more wires is the most common
finding. Other findings may be broken or rotated wire sutures.
CT may be valuable in detecting the extent of any associated wound
Treatment of sternal dehiscence is generally debridement and
Sternal dehiscence is an uncommon complication that is most
commonly diagnosed radiographically. The most common finding is
displacement of a sternotomy wire.