Chowdhury Naib, Serena Giuseppe, Velcu Laura, Barrett Leonard, Angus L D George
Department of Surgery, Nassau University Medical Center, East Meadow, USA.
Cureus. 2024 Nov 19;16(11):e74011. doi: 10.7759/cureus.74011. eCollection 2024 Nov.
A 67-year-old female presented to the emergency department after falling on her chest. On initial presentation, her chest wall was tender to palpation with mild overlying ecchymosis. Initial imaging demonstrated a sternal body fracture with minimal retrosternal hematoma. On hospital day four, a fluctuant mass was appreciated over her sternum. A repeat CT scan demonstrated an abscess collection anterior and posterior to her sternum with underlying subcutaneous emphysema. The patient was taken to the operating room for incision and drainage with sternal body debridement. Pathology resulted in acute and chronic osteomyelitis and fluid culture with (MSSA). Following infectious process resolution, the incision was closed with bilateral pectoralis advancement flaps. This case represents a rare complication of a relatively common traumatic injury, namely, a sternal fracture. In this scenario, due to the high mortality associated with mediastinitis, an immediate intervention and a multidisciplinary approach are cornerstones for optimal outcomes.
一名67岁女性在胸部着地摔倒后被送往急诊科。初次就诊时，其胸壁触诊有压痛，伴有轻度皮下瘀斑。初步影像学检查显示胸骨体骨折，胸骨后血肿轻微。住院第4天，在其胸骨上发现一个波动感肿物。重复CT扫描显示胸骨前后有脓肿形成，并伴有皮下气肿。患者被送往手术室进行切开引流及胸骨体清创术。病理结果为急性和慢性骨髓炎，液体培养结果为（甲氧西林敏感金黄色葡萄球菌）。感染过程消退后，采用双侧胸大肌推进皮瓣关闭切口。该病例代表了一种相对常见的创伤性损伤（即胸骨骨折）的罕见并发症。在这种情况下，由于纵隔炎相关的高死亡率，立即干预和多学科方法是取得最佳治疗效果的基石。
