Delayed sternal ossification in congenital heart disease: incidence using computed tomography
Kapil Wattamwar1, Terry L Levin2
1Department of Radiology, Montefiore Medical Center, 111 E. 210th St., Bronx, NY, 10467, USA. kwattamw@montefiore.org.
Insights
Delayed sternal ossification is more common in children with congenital heart disease (CHD), especially cyanotic forms. This finding in CHD patients does not require further investigation.
Area of Science:
- Pediatric Cardiology
- Medical Imaging
- Developmental Biology
Background:
- Congenital heart disease (CHD) is linked to sternal abnormalities, but delayed sternal ossification is less understood.
- Existing literature on this topic is limited and primarily based on radiographic studies.
Purpose of the Study:
- To quantitatively assess delayed sternal ossification in children with CHD using computed tomography (CT).
- To compare the prevalence of delayed sternal ossification in CHD patients versus a control group.
Main Methods:
- Chest CT scans of children under 3 years with complex CHD and controls were reviewed.
- Demographics, CHD type, and sternal ossification patterns (manubrial and sternal segments) were analyzed.
- Statistical analysis compared ossification delays between CHD patients and controls, with a significance threshold of 0.05.
Main Results:
- Delayed sternal ossification was found in 11.9% of CHD patients, significantly higher than the 1.6% in controls (P=0.002).
- Cyanotic CHD was strongly associated with delayed ossification (P<0.001), unlike acyanotic CHD (P=0.37).
- Observed ossification patterns varied, including manubrium only, manubrium and first segment, and more extensive delays.
Conclusions:
- Delayed sternal ossification is a notable finding in children with CHD, particularly those with cyanotic types.
- The presence of delayed sternal ossification in CHD patients does not necessitate additional diagnostic work-up.
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.
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