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Ann Thorac Surg 2008;86:1997. doi:10.1016/j.athoracsur.2008.03.054
© 2008 The Society of Thoracic Surgeons
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Images in Cardiothoracic Surgery

Traumatic Sternal Abscess With Mediastinal Involvement

Nishith N.B. Patel, MB, BCha, Gavin J. Murphy, MDa,*, Mark Hamilton, MDb

a Department of Cardiac Surgery, Bristol Royal Infirmary, Bristol, United Kingdom
b Department of Radiology, Bristol Royal Infirmary, Bristol, United Kingdom

* Address correspondence to Dr Murphy, Bristol Heart Institute, Bristol Royal Infirmary, Marlborough St, Bristol, BS2 8HW, United Kingdom (Email: gavin.murphy{at}bristol.ac.uk).

A 26-year-old woman with intravenous drug use presented with a hot, red, pulsatile mass (measuring 10 x 10 cm) 3 weeks after an episode of sternal trauma. An arterial phase contrast-enhanced computed tomographic thoracic scan revealed a sternal fracture with a large abscess involving the body of the sternum and tracking posteriorly to envelop the great vessels and upper pericardium. The abscess can be seen both anterior and posterior to the sternum and in close relation to the pericardium and great vessels (Fig 1; A = anterior; H = head; P = posterior; F = foot). An urgent drainage and debridement of the abscess with saline irrigation through a midline incision was performed with delayed primary closure of the skin and subcutaneous tissues after 1 week. The patient recovered well after surgical debridement and intravenous antibiotic therapy. Computed tomographic scanning with an appropriately timed contrast bolus is essential to delineate potential connections between pulsatile masses of the thorax and the arterial tree.


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