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Case of the Week 244

What's the most likely diagnosis?

  • 68 year-old 3 weeks post-aortic valve replacement

CT scout image

  1. Pericardial effusion
  2. Congestive heart failure
  3. Sternal dehiscence
  4. Left lower lobe atelectasis
  5. Metastatic disease to the lungs



3. Sternal dehiscence



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Sternal Dehiscence

General considerations

  • Follows median sternotomy usually for cardiothoracic surgery
  • Defined as complete separation of the sternum
    • Frequently associated with sternal wound infection, most often by S. aureus
    • May or may not be associated with mediastinitis
      • Definitions for post-sternal mediastinitis and sternal wound infection vary, some including clinical findings only, some requiring microbiological confirmation
  • Incidence has been reported in 4.5% of coronary artery bypass graft (CABG) surgeries
  • While diagnosis is usually made clinically, imaging plays a key role in either initial diagnosis and/or confirmation of the clinical diagnosis
  • Females are at greater risk than males


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