By Amy B. Coleman, MD, and Tom Cole, MD
Ectopic position of a fractured sternal wire fragment
No wire markers were described on the technician’
s standard mammographic questionnaire.
On questioning the technician, the absence of wire markers was
rmed. The technician
did, however, report a long mid-line scar over the sternum. The
patient was then contacted to ask about any history of chest trauma
and/or surgeries. The patient denied any history of injury to her
chest. She also denied any history of left breast pain. She did
report a relatively recent coronary artery bypass graft surgery
after which she recovered with minimal complications. On further
evaluation of the left craniocaucal and left mediolateral oblique
images, it was determined that the wire was in the central middle
third of the left breast. No associated architectural distortion or
masses were noted. The patient’
s prior chest X-rays, mammograms, and
chest computed tomograms were then reviewed. A 2001 screening
mammogram (Figure 2) and a preoperative chest X-ray (Figure 3)
revealed no such metallic density in the region of the left breast.
Postoperative chest X-rays (Figure 4) showed 4 unremarkable sternal
wires and a small left pleural effusion. </<span
>Seven months later, the patient’
s effusion had increased and a
CT-guided percutaneous drainage was required. On the images from
this procedure, the inferior-most wire was noted to be fractured
posteriorly (Figure 5). A fragment was identiﬁ
ed that extended antero-laterally
toward the left breast. </<span class="end-tag" />P
>Approximately 1 month later, a follow-up CT examination
of the chest was performed (Figure 6). On the scout image (Figure
6A), the wire could be seen in the left breast. However, this was
not noted on the initial examination, as it was not in the
eld of view of the axial
images. </<span class="end-tag" />P
>At this point, the cardiothoracic surgery service was
contacted for further evaluation of the patient. The cardiothoracic
surgeon reviewed the case and sent the patient to the breast
surgery clinic. The breast surgeons recontacted our department to
set up needle localization for excision of the wire. Six months
after the follow-up CT study, we localized the wire using a
standard technique. At surgery, a 3.2-cm wire was removed without
incident (Figure 7). </<span class="end-tag" />P
In recent medical literature, there have been many diverse cases of
migration of fractured sternal and other surgical wires in the
class="end-tag" />Sup>These were usually described as
traversing an internally directed course, such as those that
eventually impinged on and/or penetrated various cardiac
class="end-tag" />Sup>great vessels,<Sup
>4 </<span class="end-tag"
/>Sup>or the pleural cavity.<Sup
>5 </<span class="end-tag"
/>Sup>The case reported here appears unique in this respect.
</<span class="end-tag" />P
class="end-tag" />B></<span class="end-tag"
>In this case, the fractured sternal wire was migrating
peripherally into the breast, where it was removed without
complication. However, a unidirectional migration path does not
encompass all wayward wires. Thus, removal at the time of detection
appears most prudent.
>Kopans DB. Breast Imaging. 5th ed. New York, NY:
Lippincott-Raven; 1998:369. </<span class="end-tag"
>Cardenosa G. The Core Curriculum:Breast Imaging.
Philadelphia, PA: Lippincott Williams &
Wilkins; 2004:352. </<span
Rumisek JD. Intravascular migration of fractured sternal wire
presenting with hemoptysis. Ann Thorac Surg. 2001;71:1682-1684.
</<span class="end-tag" />LI
>Kao CL, Chang JP. Aortic graft pseudoaneurysm secondary
to fracture of sternal wires. Tex Heart Inst J. 2003;30:240-242.
</<span class="end-tag" />LI
>Radich GA, Altinok D, Silva J. Marked migration of
sternotomy wires: A case report. J Thoracic Imaging.
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