Traumatic Bilateral Pneumothoraces due to Sternal Wire Migration

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

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.

A runaway sternal wire: A rare case and outcome of sternal wire intravascular embolization

We present a case of a 56-year-old man with history of coronary artery disease and prior two coronary bypass surgeries, who presented with chronic chest pain and was found to have a fractured sternal wire that migrated through the right ventricle and embolized to the right lower pulmonary artery without evident hemodynamic consequences. The sternal wire migration process, in part due to patient's poor medical compliance, was captured on serial computed tomography scans over a period of several years. <Learning objective: Recognize potential sternotomy complications on imaging. Identify rare but potentially dangerous complications of sternal wire fractures. Review of the literature on sternal wire embolization.>.

Migration of trochanteric cerclage cable debris to the knee joint

Migrating orthopedic hardware has widely been reported in the literature. Most reported cases of migrating hardware involve smooth Kirschner wires or loosening/fracture of hardware involved with joint stabilization/fixation. It is unusual for hardware to migrate within the soft tissues. In some cases, smooth Kirschner wires have migrated within the thoracic cage—a proposed mechanism for this phenomenon is the negative intrathoracic pressure. While wires have also been reported to gain access to circulation, transporting them over larger distances, the majority of broken or retained wires remain local. We report a case of a 34-year-old man in whom numerous fragments of braided cable migrated from the hip to the knee.

Unusual cause of intraoperative hemoptysis

We present a rare complication of sternotomy wire removal in a patient with history of coronary artery bypass graft four years prior now undergoing redo sternotomy for aortic valve replacement. Upon removal of the third sternotomy wire the patient experienced hemoptysis from intrapulmonary hemorrhage, requiring that the procedure be aborted; careful review of preoperative computed tomography (CT) demonstrated this sternotomy wire to be traversing through lung parenchyma.