Delayed sternal ossification in congenital heart disease: incidence using computed tomography

Abstract

Background: While congenital heart disease (CHD) is known to be associated with sternal abnormalities, its association with absent sternal ossification is less well known. The literature is sparse and based on radiographs.

Objective: To quantify delayed sternal ossification in CHD using computed tomography (CT).

Materials and methods: An imaging database search identified children with complex CHD and controls younger than 3 years of age who underwent chest CT from 2010 to 2019. Records were reviewed for demographics, CHD type and other pertinent history. Images were reviewed for manubrial or sternal segment ossification. Controls consisted of children undergoing chest CT for noncardiac reasons. Statistical analyses were conducted using a significance threshold of 0.05.

Results: Fifty-nine children had complex CHD (mean age: 9.4 months); 36 (61.0%) had cyanotic CHD. There were 189 controls (mean age: 17.9 months). Delayed sternal ossification was present in 7 children (11.9%) in the study group; 6 had cyanotic heart disease (85.7%). Patterns of ossification included manubrium only; manubrium and first sternal segment; first and second sternal segments; and manubrium, first segment and hypoplastic second segment. Three controls (1.6%) had sternal ossification delay, all with manubrial ossification only. Delayed sternal ossification was more prevalent in the study group than in the controls (P=0.002). Compared to the controls, a higher incidence of delayed sternal ossification was seen in children with cyanotic CHD (P<0.001) but not acyanotic CHD (P=0.37).

Conclusion: Delayed sternal ossification occurs in children with CHD, particularly cyanotic forms, and requires no additional work-up.

Keywords: Children; Computed tomography; Congenital heart disease; Ossification; Sternum.