Bifid sternum in a young woman: Multimodality imaging features

Abstract

Bifid sternum is a rare fusion anomaly of the chest wall that accounts for 0.15% of all chest deformities and may be associated with cardiac or vascular anomalies. It is usually diagnosed and surgically corrected at birth or within the first month of life. Being a diagnosis made during the neonatal period, computed tomography scan and magnetic resonance imaging are not often performed; not so many cases in literature have been studied with II level diagnostic imaging, such as computed tomography or magnetic resonance.We describe a case of bifid sternum, rarely diagnosed in adults, discovered in a 21-year-old woman who came to our Diagnostic Imaging Department to perform a chest magnetic resonance after a chest X-ray.

Successful surgical repair of a sternum cleft using composite mesh: A case report and new technical note

“…[1] Multiple embryological studies of the sternum have attributed the sternal cleft to a defect in fusion of the two sternal bands from the lateral plate mesoderm, which normally occurs around the ninth week of intrauterine life in the craniocaudal direction. [1,[3][4][5][6] The cleft may involve the manubrium and upper sternebrae, the lower sternum saving the xiphoid process, but also the entire sternum. Therefore, sternal clefts are classified as incomplete and partial forms, which can be superior or inferior.…”

“…Therefore, sternal clefts are classified as incomplete and partial forms, which can be superior or inferior. [4,5] According to Ravitch, [7] classification of sternal clefts may be in the form of: • Complete bifid sternum with or without ectopia cordis or herniation of pericardium known as Cantrell pentalogy (congenital sternal cleft, omphalocele, anterior diaphragmatic hernia, ectopia cordis, and a variety of intracardiac defects). • Fusion at only upper or lower parts of sternal plates (isolated sternal defects).…”

“…[3,8] There is no reported justification for the predominantly female prevalence of the condition. [3][4][5] However, studies by Gorlin et al [13] and Heron et al [14] showed a predominance of females when the sternal cleft is associated with a bandlike scar from the umbilicus and diastasis recti.…”

“…CT is considered the best technique for studying sternal anatomy, offering the possibility to perform 3D evaluation, which can help the surgeon in surgical repair of the sternal cleft. [5][6] Historically, Lannelongue [1] carried out the first surgical repair of a complete sternal cleft in 1988. Burton [8] published two cases of successful surgical repair by implanting a cartilage graft in the defect in the bone in 1947.…”

“…[5,8] Beyond one year, autologous grafts (costal cartilage, parietal skull, tibial periosteum) or prosthetic materials such as Marlex mesh, Teflon mesh, silicone elastomer and acrylic are required. [5][6] Moreover, studies have suggested that it is always preferable to use autogenous tissue for sternal cleft repair and to avoid the use of prosthetic materials, recognising the risk of infection and the negative impact of inert material on the patient's development. [1,4,8] Despite the risk of infection described in the literature, the use of prosthesis in sternal cleft repair has an advantage in preventing an increase in intrathoracic pressure such as explained in our technical note.…”