Computed tomography of the sternum and mediastinum after median sternotomy

Background. Computed tomography is used in our hospital to diagnose complic ations after median sternotomy, but its efficiency is unknown. Nor is the c omputed tomographic appearance of normal healing of a median sternotomy kno wn. Computed tomography was evaluated for its ability to diagnose mediastin itis and sternal dehiscence, and a reference material of normally healing m edian sternotomies was created. Methods. In a prospective study, 20 patients with a normally healing median sternotomy were examined 1 week, 1 month, 3 months, and 6 months after ope ration. In a retrospective study, 87 scans from 65 patients that were made because a postoperative complication was suspected were reviewed. Results. In the prospective study, all patients had clinically uneventful h ealing. None of the computed tomographic scans showed radiologic signs of h ealing at 3 months. At 6 months, half of the patients had healed completely . In the retrospective study, 49 scans were performed on suspicion of infec tion; 7 of them indicated mediastinitis, 2 were false-positive, while media stinitis was present in a total of 16 of the scans. Thirty-eight scans were made because of sternal pain or suspected dehiscence; after 21 of the scan s, recovery was uneventful, and in 11, the definite diagnosis was dehiscenc e or pseudarthrosis. Conclusions. Clinical healing of the sternotomy does not correlate with the computed tomographic image. Computed tomography is not a sensitive tool fo r diagnosing mediastinitis, and in patients with sternal pain, it adds litt le information. (Ann Thorac Surg 1999;68:858-63) (C) 1999 by The Society of Thoracic Surgeons.