Early detection of sternal dehiscence by conventional chest X-ray.
BACKGROUND
Diagnosis of sternal dehiscence after sternotomy for cardiac surgery is still made clinically. The aim of this study was to identify radiographic signs of sternal dehiscence by routine chest X-ray (CXR) in patients with and without clinically diagnosed sternal dehiscence.


METHODS
75 patients (group I: 65 +/- 9.3 years, f/m = 12/63) with clinically diagnosed sternal dehiscence, necessitating surgical revision and 75 patients with uneventful sternal healing (matched to group I by age, sex, preoperative risk factors and surgical procedures; group II: 66 +/- 9.0 years, f/m = 12/63) were included in this study. Serial CXRs immediately after surgery until re-intervention or discharge were analyzed by a radiologist, blind to the date of redo surgery.


RESULTS
In 39 patients of group I (52%) vs. 8 (10.7%) in group II, abnormalities in the sternal wire and/or a midsternal stripe could be found (p < 0.0001): rotated wires (p = 0.003), shifted wires (p = 0.043), and ruptured wires (p = 0.312). Seven patients presented with combined wire abnormalities in group I vs. 0 in group II. Midsternal stripe sign could be detected in 26 patients of group I vs. 3 in group II (p < 0.0001). Sternal dehiscence was suspected based on the above mentioned abnormalities as early as three days postoperatively (Q1 = 2; Q3 = 8 days) in 39 patients, whereas clinical diagnosis of sternal dehiscence was delayed up to ten days postoperatively (Q1 = 7; Q3 = 13 days).


CONCLUSIONS
Radiographic signs of sternal dehiscence could be detected before the clinical diagnosis was apparent and predicted sternal dehiscence in more than half of the patients.
Department of Cardiothoracic and Vascular Surgery, Johannes Gutenberg University Hospital, Mainz, Germany. peivandi@uni-mainz.de
A A
AA
Peivandi
N
N
Vogel
U T
UT
Opfermann
J
J
Singelmann
W
W
Kuroczynski
K F
KF
Kreitner
M
M
Dahm
C F
CF
Vahl
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013249:Sternum; D013529:Surgical Wound Dehiscence / Q000000981:diagnostic imaging*; D013908:Thoracotomy / Q000009:adverse effects*; D014945:Wound Healing