title: Computed tomography of the sternum and mediastinum after median sternotomy.
abstract: BACKGROUND
  Computed tomography is used in our hospital to diagnose complications after median sternotomy, but its efficiency is unknown. Nor is the computed tomographic appearance of normal healing of a median sternotomy known. Computed tomography was evaluated for its ability to diagnose mediastinitis and sternal dehiscence, and a reference material of normally healing median sternotomies was created.
  
  
  METHODS
  In a prospective study, 20 patients with a normally healing median sternotomy were examined 1 week, 1 month, 3 months, and 6 months after operation. In a retrospective study, 87 scans from 65 patients that were made because a postoperative complication was suspected were reviewed.
  
  
  RESULTS
  In the prospective study, all patients had clinically uneventful healing. None of the computed tomographic scans showed radiologic signs of healing at 3 months. At 6 months, half of the patients had healed completely. In the retrospective study, 49 scans were performed on suspicion of infection; 7 of them indicated mediastinitis, 2 were false-positive, while mediastinitis was present in a total of 16 of the scans. Thirty-eight scans were made because of sternal pain or suspected dehiscence; after 21 of the scans, recovery was uneventful, and in 11, the definite diagnosis was dehiscence or pseudarthrosis.
  
  
  CONCLUSIONS
  Clinical healing of the sternotomy does not correlate with the computed tomographic image. Computed tomography is not a sensitive tool for diagnosing mediastinitis, and in patients with sternal pain, it adds little information.
authors.affiliation: Department of Thoracic Surgery, Karolinska Hospital, Stockholm, Sweden. catarina.bitkover@thxkir.ks.se
authors.forename: C Y
authors.initials: CY
authors.lastname: Bitkover
authors.forename: K
authors.initials: K
authors.lastname: Cederlund
authors.forename: B
authors.initials: B
authors.lastname: Aberg
authors.forename: J
authors.initials: J
authors.lastname: Vaage
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000000981:diagnostic imaging / Q000209:etiology; D008482:Mediastinum / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012189:Retrospective Studies; D013249:Sternum / Q000000981:diagnostic imaging* / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed