Migrated fractured sternal wire in proximity to the main pulmonary artery: Case report and review

Abstract

Background We present a case of a 83‐year‐old man with a prior history of coronary artery bypass who presented to his family physician with progressive symptoms that raised concern for heart failure exacerbation. A chest X‐ray was performed, which showed a fractured topmost sternal wire in the lateral projection and indicated that the sternal wire had migrated into the anterior mediastinum. An emergent electrocardiogram‐gated flash computed tomography angiography confirmed the location of the fractured wire to be in close proximity to the main pulmonary artery. A discussion of migrated sternal wires with a literature review of cases is provided as well. Aims To present a case of a migrated sternal wire and a literature review. Methods An extensive literature review using pubmed and medline with relevant keywords was preformed. Results 11 known cases of migrated sternal wires with various complications, as detailed in the review table. The mortality rate is low but can be associated with significant morbidity. Discussion Fractured wires are quite common and are usually a benign radiographic finding. However, migration of sternal wires is an extremely rare phenomenon. Only a few reported cases in the literature were sternal wires have migrated beyond the sternum, leading to catastrophic clinical consequences, as detailed in the review table. Conclusion Sternal wire complications secondary to migration beyond the sternum are rare but potentially fatal. Precise wire location and risk assessment with CT are more appropriate when wire location cannot be clearly delineated by plain film radiography.

Urgent Frozen Elephant Trunk for an Aortic Arch Pseudoaneurysm Secondary to Fractured Sternal Wire

“…To our knowledge, the only other case of chronic sternal wire erosion of the ascending thoracic aorta following repair of aortic dissection was published in 2003 (4). Other reports of sternal wire migration to the pulmonary artery (5) and right ventricle(6) have also been described.…”

Injury to a cardiopulmonary resuscitation provider by sternal wire

“…However, because sternal wire fractures or unraveling wire sutures are usually clinically silent, damage to patients has been reported, including embolization of the pulmonary arteries or migration to the anterior mediastinum owing to wire breakage or deviation. 3 , 4 …”

“… 2 Many reports of patient injury are associated with wire breakage or deviation, due to which the wire penetrates the anterior mediastinum or aorta. 3 , 4 However, only a few reports of healthcare worker injuries caused by sternal wire movement. Here, we report a case where a sternal wire injured a CPR provider involved in manual chest compression.…”

Spinal K-Wire Migration Following Acromioclavicular Dislocation Surgical Treatment: a Case Report With Scoping Review Discussion

“…The preferred imaging is an X-ray to assess the presence of spinal wire migration, but when the wire cannot be clearly seen in plain radiography, assessing the risk via CT scan is more preferable to determine the exact location of the wire (Mokhtar, et al, 2020). CT angiography must be done if any major vessel damage is involved (Mankowski, et al, 2016).…”