Incidentally Detected Sternal Foramen during an Urgent Surgical Revascularization: A Case Report

Abstract

The sternal foramen is an anatomical variation at the lower third of the sternum which carries the risk of life-threatening complications such as pneumothorax. It is usually asymptomatic and can be misinterpreted as an acquired lesion. The sternum is close to the mediastinal structures; the sternal foramen, thus, leaves the lung, heart, and great vessels unprotected during invasive procedures. A 61-year-old male patient was admitted to our emergency department with sudden-onset chest pain. Acute coronary syndrome was diagnosed by the cardiology department. Coronary angiography confirmed the diagnosis of coronary artery disease, and the patient underwent urgent coronary artery bypass grafting. During the exploration, sternotomy was performed with a proper incision. Two sternal images were obtained via the median incision, and a sternal foramen was detected intraoperatively. To the best of our knowledge, this is the first case of sternotomy to undergo open-heart surgery for coronary heart disease and to be diagnosed with the sternal foramen intraoperatively. It is of vital importance that surgeons and interventionists recognize the sternal foramen, which leaves the mediastinal structures unprotected, and take early precautions.

Keywords: Anatomic variation; Coronary artery disease; Sternotomy.

Figure 1

Chest X-ray of the patient in the posteroanterior view, failing to demonstrate the foramen

Figure 2

A) Right part of the mid-sagittal image after median sternotomy, showing the foramen and the anatomical parts of the sternum (arrows), B) Left part of the mid-sagittal image after median sternotomy, showing the foramen and the anatomical parts of the sternum (arrows)

Figure 3

Postoperative anterior oblique plane 3D computed tomography image, showing the foramen (arrow)