CTICasesEarly Sternal Disruption after Coronary Artery Bypass Grafting
Imaging findings
Chest radiograph and chest CT obtained 5 to 6 days post-coronary artery bypass graft surgery demonstrate a dramatic diastasis of the sternal osteotomy with a large gap between the sternal halves. Multiple sternal wires have torn completely through the bone, with some wires remaining associated with either the left or right sternal margins, and one intact wire remaining at the manubrium. There is no discrete mediastinal abscess, but a small amount of fluid and air is present within the gap.
Key takeaways
Sternal dehiscence or disruption is a serious complication of median sternotomy that typically occurs 2 to 4 weeks after surgery. Finding dramatic sternal disruption as early as 5 to 6 days post-operatively is highly unusual and suggests either extreme mechanical stress (e.g., vigorous coughing) or poor bone quality, rather than a primary infectious mediastinitis. Urgent surgical revision and sternal rewiring are required to stabilize the chest wall.
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