Primary Sternal Osteomyelitis with Acute Mediastinitis, Successfully Treated with Minimally Invasive Surgical
Iori Tsuji1, Fumihiko Kinoshita1,2, Yoshiyuki Nakanishi2
1Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan.
Introduction:
Primary sternal osteomyelitis (PSO) is a rare disease that occurs without any contiguous focus of infection, and there are few reports of acute mediastinitis due to PSO. In this report, we describe a case of PSO with acute mediastinitis successfully treated with a minimally invasive approach.
Case Presentation:
A 71-year-old man visited his local doctor for anterior chest pain. He had no history of trauma or chest surgery. He was treated conservatively because of a few abnormalities on CT. However, his symptoms worsened, and a CT was re-taken 13 days later. The CT showed an abscess on the left side of the anterior mediastinum and subcutaneous tissues, as well as destruction of the sternum. With the diagnosis of acute mediastinitis and mediastinal abscess, thoracoscopic and subcutaneous drainages of the abscess were performed. After surgery, blood culture examination showed methicillin-sensitive Staphylococcus aureus, and we judged the mediastinitis to be caused by PSO. The thoracic drain was removed on postoperative day 39, the open subcutaneous wound closed spontaneously, and the patient was discharged on postoperative day 45. He continued oral antibiotics for the next 2 months, and the abscess cavity completely resolved.
Conclusions:
Although PSO is rare, it can lead to mediastinitis and should be suspected when anterior chest pain is present. Our case of PSO with acute mediastinitis progressed rapidly over a few days but could be treated with minimally invasive thoracoscopic and subcutaneous drainages, without the need for invasive sternal debridement and drainage.
Insights
Primary sternal osteomyelitis (PSO) can cause acute mediastinitis. This case highlights successful minimally invasive treatment for PSO with mediastinitis, avoiding extensive surgery.
Area of Science:
- Thoracic surgery
- Infectious disease
- Osteomyelitis research
Background:
- Primary sternal osteomyelitis (PSO) is a rare infection without a contiguous source.
- Acute mediastinitis is an uncommon complication of PSO.
- This report details a unique case of PSO leading to acute mediastinitis.
Observation:
- A 71-year-old male presented with chest pain, initially treated conservatively.
- Subsequent imaging revealed sternal destruction, mediastinal abscess, and subcutaneous infection.
- Methicillin-sensitive Staphylococcus aureus was identified as the causative agent.
Findings:
- The patient underwent successful minimally invasive thoracoscopic and subcutaneous drainage.
- Complete resolution of the abscess cavity was achieved with oral antibiotics.
- The patient was discharged on postoperative day 45.
Implications:
- PSO, though rare, must be considered in patients with anterior chest pain.
- Minimally invasive approaches can be effective for PSO-induced mediastinitis.
- This case suggests avoiding extensive sternal debridement in select cases.
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