The Midsternal Stripe: A Sign of Dehiscence Following Median Sternotomy

Abstract

Sternal dehiscence is a recognized complication of median sternotomy in 2.5-4.8% of patients. The authors describe the prognostic significance of a lucent midsternal stripe which was seen in 12 patients over a two-year period. Sternal dehiscence requiring surgical revision developed in 4, and radiological suspicion preceded clinical evidence of dehiscence in 3 of them. A review of 100 consecutive median sternotomies revealed that sternal dehiscence did not develop in any patient who did not have a midsternal stripe. It is suggested that this may be a useful tool in identifying those patients who are at high risk of the development of sternal dehiscence.

A Closer Look at the Midsternal Stripe Sign

“…The midsternal stripe sign was first described by Escovitz et al [8], who detected a midsternal radiolucency in 12 of 250 postoperative patients during a 2-year period and found that sternal dehiscence developed in four of these patients. A review by the same authors of the cases of 100 consecutive patients who had undergone median sternotomy revealed that sternal dehiscence did not develop in any patient who did not have a midsternal stripe.…”

“…Thus, there has been a longstanding interest in determining whether radiography could be used in identifying this complication [8][9][10]. Two major radiographic signs have been described: the midsternal stripe sign and sternal wire displacement.…”

“…Each radiograph was retrospectively reviewed by two radiologists, and findings were determined by consensus. Radiographs were assessed for the presence of a midsternal stripe, which was defined as a midline vertical radiolucency overlying the sternum [8], and sternal wire displacement, which was defined as one or more wires misaligned in relation to others in the vertical row [5] (Fig. 1).…”

“…ternal dehiscence is an uncommon but serious complication of median sternotomy [1][2][3][4][5][6][7]. The interest in establishing the radiographic diagnosis of this complication is long-standing [8][9][10]. Two major radiographic signs have been described: the midsternal stripe sign (a midline vertical radiolucency overlying the sternum) [8][9][10] and sternal wire displacement [10] (one or more wires misaligned with respect to others in the vertical row).…”

“…The interest in establishing the radiographic diagnosis of this complication is long-standing [8][9][10]. Two major radiographic signs have been described: the midsternal stripe sign (a midline vertical radiolucency overlying the sternum) [8][9][10] and sternal wire displacement [10] (one or more wires misaligned with respect to others in the vertical row). Although the latter sign has been shown to be highly specific for dehiscence [5][6][7], reports in the literature offer conflicting assessments regarding the relevance of the midsternal stripe sign in the diagnosis of dehiscence [8][9][10].…”