Hemothorax After Delayed Fracture of Sternal Wire Breanna Gawrys, DO, Phillip Mullenix, MD, and Daniel G. Nicastri, MD
FEATURE ARTICLES
Department of Family Medicine, Fort Belvoir Community Hospital, Fort Belvoir, Virginia; and Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
Fig 2.
Fig 1.
A
22-year-old woman who was 1 month postpartum from an uncomplicated vaginal delivery had undergone uncomplicated atrial septal defect repair by a sternotomy at age 13 presented with 4 days of dyspnea and pleuritic chest pain. She was hemodynamically stable. A chest roentgenogram revealed a large right pleural effusion and atelectasis. Subsequent computed tomography scan (Fig 1) demonstrated a fractured sternal wire, a fragment of which extended posteriorly into the anterior mediastinum. She underwent exploratory thoracoscopy and approximately 2 liters of blood were evacuated from the right chest. Minor bleeding from the anterior segment of the right upper lobe was identified. A staple was used to divide the anterior segment of the upper lobe, leaving it
Address correspondence to Dr Nicastri, 919 Plymouth St, Pelham, NY 10803; e-mail: [email protected].
Ó 2015 by The Society of Thoracic Surgeons Published by Elsevier
attached to the chest wall. Because the sternal wire was embedded in the segment, the wire was divided through a 5-cm open port (Fig 2), and the segment was removed. She required no transfusion. The patient had an uncomplicated postoperative course and was discharged on day 2. Sternal wire migration is generally treated conservatively unless complications occur [1]. Reported complications include fistula formation, traumatic pneumothoraces [1], tamponade from right ventricular injury [2], and aortic injury [3]. Such complications, left untreated, can be fatal.
References 1. Imran Hamid U, Gillespie S, Lynchehaun C, Parissis H. Traumatic bilateral pneumothoraces due to sternal wire migration. Case Rep Med 2012;2012:438429. 2. Lee SH, Cho BS, Kim SJ, et al. Cardiac tamponade caused by broken sternal wire after pectus excavatum repair: a case report. Ann Thorac Cardiovasc Surg 2013;19:52–4. 3. Mieno S, Ozawa H, Katsumata T. Ascending aortic injury caused by a fractured sternal wire 28 years after surgical intervention of pectus excavatum. J Thorac Cardiovasc Surg 2010;140:e18–20.
Ann Thorac Surg 2015;99:1086 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2014.11.013
FEATURE ARTICLES
Department of Family Medicine, Fort Belvoir Community Hospital, Fort Belvoir, Virginia; and Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
Fig 2.
Fig 1.
A
22-year-old woman who was 1 month postpartum from an uncomplicated vaginal delivery had undergone uncomplicated atrial septal defect repair by a sternotomy at age 13 presented with 4 days of dyspnea and pleuritic chest pain. She was hemodynamically stable. A chest roentgenogram revealed a large right pleural effusion and atelectasis. Subsequent computed tomography scan (Fig 1) demonstrated a fractured sternal wire, a fragment of which extended posteriorly into the anterior mediastinum. She underwent exploratory thoracoscopy and approximately 2 liters of blood were evacuated from the right chest. Minor bleeding from the anterior segment of the right upper lobe was identified. A staple was used to divide the anterior segment of the upper lobe, leaving it
Address correspondence to Dr Nicastri, 919 Plymouth St, Pelham, NY 10803; e-mail: [email protected].
Ó 2015 by The Society of Thoracic Surgeons Published by Elsevier
attached to the chest wall. Because the sternal wire was embedded in the segment, the wire was divided through a 5-cm open port (Fig 2), and the segment was removed. She required no transfusion. The patient had an uncomplicated postoperative course and was discharged on day 2. Sternal wire migration is generally treated conservatively unless complications occur [1]. Reported complications include fistula formation, traumatic pneumothoraces [1], tamponade from right ventricular injury [2], and aortic injury [3]. Such complications, left untreated, can be fatal.
References 1. Imran Hamid U, Gillespie S, Lynchehaun C, Parissis H. Traumatic bilateral pneumothoraces due to sternal wire migration. Case Rep Med 2012;2012:438429. 2. Lee SH, Cho BS, Kim SJ, et al. Cardiac tamponade caused by broken sternal wire after pectus excavatum repair: a case report. Ann Thorac Cardiovasc Surg 2013;19:52–4. 3. Mieno S, Ozawa H, Katsumata T. Ascending aortic injury caused by a fractured sternal wire 28 years after surgical intervention of pectus excavatum. J Thorac Cardiovasc Surg 2010;140:e18–20.
Ann Thorac Surg 2015;99:1086 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2014.11.013
