An Unusual Case of Sternal Osteomyelitis and Purulent Mediastinitis After a Traumatic Sternal Body Fracture

Abstract

A 67-year-old female presented to the emergency department after falling on her chest. On initial presentation, her chest wall was tender to palpation with mild overlying ecchymosis. Initial imaging demonstrated a sternal body fracture with minimal retrosternal hematoma. On hospital day four, a fluctuant mass was appreciated over her sternum. A repeat CT scan demonstrated an abscess collection anterior and posterior to her sternum with underlying subcutaneous emphysema. The patient was taken to the operating room for incision and drainage with sternal body debridement. Pathology resulted in acute and chronic osteomyelitis and fluid culture with methicillin-sensitive Staphylococcus aureus (MSSA). Following infectious process resolution, the incision was closed with bilateral pectoralis advancement flaps. This case represents a rare complication of a relatively common traumatic injury, namely, a sternal fracture. In this scenario, due to the high mortality associated with mediastinitis, an immediate intervention and a multidisciplinary approach are cornerstones for optimal outcomes.