A radiologist's guide to median sternotomy.

Area of Science:

• Cardiovascular Surgery
• Medical Imaging
• Thoracic Surgery

Background:

• Median sternotomy is the standard surgical approach for cardiac procedures.
• It provides essential access for congenital heart defect repair and coronary artery bypass graft (CABG) surgery.
• Understanding post-sternotomy complications is vital for patient management.

Purpose of the Study:

• To provide a comprehensive imaging review of pre-procedural assessment for median sternotomy.
• To outline imaging features of mediastinal adhesions and safe distances for re-sternotomy.
• To discuss a spectrum of post-sternotomy complications, including bone, metalwork, and soft tissue issues.

Main Methods:

• Review of clinical experience at a tertiary cardiothoracic centre.
• Focus on imaging features relevant to pre-procedural planning and complication identification.
• Inclusion of visual examples to illustrate key concepts.

Main Results:

• Detailed imaging characteristics of mediastinal adhesions.
• Establishment of minimal safe distances between the sternum and mediastinal structures for re-sternotomy.
• Categorization and description of common post-sternotomy complications: sternal wire fracture, sternal dehiscence, non-union, osteomyelitis, abscess, and haematoma.

Conclusions:

• Accurate pre-procedural imaging is crucial for safe median sternotomy and re-sternotomy.
• Recognition of specific imaging findings aids in diagnosing and managing post-sternotomy complications.
• This review provides a valuable resource for clinicians managing patients undergoing or having undergone median sternotomy.