Ann Thorac Surg 2005;80:348
© 2005 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Destructive Sternitis 3 Years After Blunt Chest Trauma
Christophe P.M. Jayle, MD*,
Pierre J. Corbi, MD,
Sebastien Franco, MD,
Paul M. Menu, MD
Cardiothoracic Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
* Address reprint requests to Dr Jayle, Unité de Chirurgie Cardio-thoracique, Pavillon Beauchant, CHU de Poitiers, 1 Rue de la Milètrie, BP 577, Poitiers Cedex 86021, France; (Email: c.jayle{at}chu-poitiers.fr).
We report the case of a 14-year-old male patient injured in a motor vehicle collision that resulted in closed, blunt chest trauma and cervical spinal trauma. Initial chest roentgenogram revealed hemothorax without ribs or sternum fracture, and he was medically treated without a chest tube. Transesophageal echocardiography was negative. Initially he had an unstable C5 fracture with spinal cord section. Surgical decompression of the spinal canal and stabilization of the fracture was made without recovery below the C5 level. The patient was quadriplegic. He was discharged from the hospital 3 months after his injury. He lived at home without respirator, without tracheotomy, and he moved around with a wheelchair and attended school.
Three years after the injury as previously described, he was admitted in the hospital with a fluctuant, upper midline, and anterolateral chest wall collection. His leukocyte count was 16,000/mL, and he had a fever of 38.8°C. Computed tomographic scan of the chest revealed sternum osteomyelitis in the upper body of the sternum (Fig 1), with pre-sternum and retro-sternum abscesses (Fig 2). A Staphylococcus aureus was surgically drained and the sternum wound was widely debrided. Drainage without irrigation was maintained for 15 days and antibiotic therapy for 6 weeks. The mediastinal defect was not reconstructed with respect to the pectoralis major muscle flap, which was necessary to move around with a wheelchair. Three weeks later the patient returned home. There was no evidence of local infection. His hemogram was normal. Pathologic examination of the sternum did not show tumoral process. The aggressive surgical debridement and antibiotic therapy were key treatments for a successful outcome. Three months after this abscess the patient was able to move again with a wheelchair.
This occurrence most likely represents bacterial seeding of a probable, initial sternum fracture from a distant source. We believe that posttraumatic bacterial sternum abscess resulting from closed blunt trauma without penetrating injury, cardiopulmonary resuscitation, or tracheal or esophageal rupture has not been previously reported.
