Incidentally Detected Sternal Foramen during an Urgent Surgical Revascularization: A Case Report

The sternal foramen is an anatomical variation at the lower third of the sternum which carries the risk of life-threatening complications such as pneumothorax. It is usually asymptomatic and can be misinterpreted as an acquired lesion. The sternum is close to the mediastinal structures; the sternal foramen, thus, leaves the lung, heart, and great vessels unprotected during invasive procedures. A 61-year-old male patient was admitted to our emergency department with sudden-onset chest pain. Acute coronary syndrome was diagnosed by the cardiology department. Coronary angiography confirmed the diagnosis of coronary artery disease, and the patient underwent urgent coronary artery bypass grafting. During the exploration, sternotomy was performed with a proper incision. Two sternal images were obtained via the median incision, and a sternal foramen was detected intraoperatively. To the best of our knowledge, this is the first case of sternotomy to undergo open-heart surgery for coronary heart disease and to be diagnosed with the sternal foramen intraoperatively. It is of vital importance that surgeons and interventionists recognize the sternal foramen, which leaves the mediastinal structures unprotected, and take early precautions.

A COMPREHENSIVE STUDY OF STERNAL FORAMEN IN DRY STERNUM

Introduction: Congenital defects during the development of sternum give rise to sternal foramen. These defects are due to incomplete fusion of sternebrae. Serious life-threatening complications can occur during sternal puncture for bone marrow biopsy. Therefore, knowledge of the presence of sternal foramen is important to prevent these life-threatening complications. Our aim was to observe the incidence, location, number and shape of the sternal foramen in dry sterna. Material & Methods: The present study was conducted in Department of Anatomy, Subharti Medical College, Meerut in 100 dry sterna. Various types of sternal variations were observed and documented. Results: In our study, 10% of the sterna had a sternal foramen. Single sternal foramen was present in 8 specimens (8%). Double foramina were present in 2 bones (2%). Conclusion: Sternal foramen are not uncommon. Knowledge of these variations are important for radiologists and surgeons during bone marrow biopsy.

Multidetector computed tomography (MDCT) estimation of prevalence and anatomic characteristics of the sternal body foramen in the population of central Serbia

Background/Aim. The most frequent form of sternal defects is a single foramen, usually located at the distal half of the sternal body, with prevalence that varies among different ethnic populations. Clinical importance of these defects arises from various diagnostic and therapeutic sternal treatments and close location of heart, lungs and other vital organs of the chest cavity. The aim of this study was to determine the prevalence and morphometric characteristics of the sternal midline foramen in the population of central Serbia. Methods. The multidetector computed tomography (MDCT) chest images of 422 patients of both genders were analyzed. The radiological imaging was performed on 64- slice MDCT scanner (Aquilion 64, Toshiba, Japan). All scans were performed in the axial plane, with subsequent multiplanar reconstruction (MPR). Due to the angulation of the sternal body coronal curved-planar, the images were obtained in order to show the whole length of the sternum and the vertical diameter of the sternal foramen. The measurements were done using the commercially available software (Imaging Software ver. 4.1.14.0, Vital-Images). Results. The solitary foramen, located in the distal segment of the sternal body, was detected in 24 patients, representing 5.9% of the observed population with slightly higher prevalence in males. The average size of foramen was 3.9 ? 4.2 mm. The mean distance from the skin was 12.7 ? 3.3 mm, the distance from skin to pericardium was on average 37.3 ? 8.2 mm, while the average distance from skin to pleura was 25 ? 5.9 mm. The average depth of foramen 8.7 ? 2 mm, while the mean distance from the posterior surface of foramen to pericardium was 12.7 ? 9.1 mm. Conclusion. The results presented in this paper confirmed the prevalence of 5.9% regarding the midline sternal foramen in the observed population. Serious complications of the sternal puncture could be prevented by prior MDCT imaging.