Ann Thorac Surg 2007;83:1900
© 2007 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Congenital Sternal Cleft in an Adult Male Not Associated With Cardiac Defects or Ectopia Cordis
Dimitrios Pousios, MD*,
Nikolaos Panagiotopoulos, MD,
Anastasios Piyis, MD
Thoracic Surgery Department, General Army Hospital of Athens, Athens, Greece
* Address correspondence to Dr Pousios, Papanikolaou 7 str, Patima Halandriou, Athens, 15238 Greece (Email: dpousios{at}yahoo.com).
A 30-year-old recruited soldier was referred to our department with hypertension, sinus tachycardia, and dyspnea. His medical history showed an allergy to pollen. A physical examination showed a palpable cleft along the full length of the sternum with the heart and ascending aorta lying immediately under the skin of the anterior thoracic surface with visible beats and evident palpation of the organs. This produced protrusion and retraction movement on respiration, coughing, or Valsalva maneuver. Hepatomegaly was also noted.
At presentation he was examined with a simple roentgenogram followed by a computed tomographic chest roentgenogram with three-dimensional reconstruction that revealed the sternum being divided from the manubrium to the xiphoid recess (Fig 1, view from above). The sternal bars were in contact only in the lower portion formatting a wide "U" shape. Computed tomographic chest roentgenogram showed the heart in a normal position. The heart ultrasonography was within normal limits. Bronchoscopy and spirometry were executed to determine the cause of dyspnea and were also within normal limits. Ultrasonography and scintigraph (Tc99m) of the kidneys showed no lesion that could cause hypertension.
Clinical and laboratory examinations showed no organic cause for hypertension, tachycardia, and dyspnea. The sternal cleft was not associated with cardiac defect or ectopia cordis. Symptoms were attributed to stressful situations as deducted from psychiatric evaluation. After a 5-day stay, the patient recovered and was discharged. Surgical treatment was offered because this anomaly could prove dangerous for the underlying mediastinal structures; however the patient refused to be operated on. He was relieved of military service. Six months later he remained in good condition.
Sternum in embryologic life has its origin in the same lateral plate mesoderm that gives rise to the pectoral muscles. At 6 weeks, the migrating cells form two bands on either side of the anterior chest wall and finally become fused by the tenth week [1]. The manubrium is formed by primordia between the ventral ends of the developing clavicles. In rare cases the sternal bars do not become joined at all or only in the lower portion and leave a superior defect. Primary repair by surgical correction with approximation of sternal parts in the neonatal period should be the best management for this rare situation [2].
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References
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- Firmin RK, Fragomeni LS, Lenox SC. Complete cleft sternum Thorax 1980;35:303-306.[Abstract/Free Full Text]
- Knox L, Tuggle D, Knott-Craig J. Repair of congenital sternal clefts in adolescence and infancy J Ped Surg 1994;29:1513-1516.[Medline]
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