Tsuji Iori, Kinoshita Fumihiko, Nakanishi Yoshiyuki, Akamine Takaki, Kohno Mikihiro, Ozono Keigo, Takenaka Tomoyoshi, Yoshizumi Tomoharu
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan.
Department of Thoracic Surgery, Kyushu University Hospital, Fukuoka, Fukuoka, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.25-0056. Epub 2025 Jul 19.
Primary sternal osteomyelitis (PSO) is a rare disease that occurs without any contiguous focus of infection, and there are few reports of acute mediastinitis due to PSO. In this report, we describe a case of PSO with acute mediastinitis successfully treated with a minimally invasive approach.
A 71-year-old man visited his local doctor for anterior chest pain. He had no history of trauma or chest surgery. He was treated conservatively because of a few abnormalities on CT. However, his symptoms worsened, and a CT was re-taken 13 days later. The CT showed an abscess on the left side of the anterior mediastinum and subcutaneous tissues, as well as destruction of the sternum. With the diagnosis of acute mediastinitis and mediastinal abscess, thoracoscopic and subcutaneous drainages of the abscess were performed. After surgery, blood culture examination showed methicillin-sensitive , and we judged the mediastinitis to be caused by PSO. The thoracic drain was removed on postoperative day 39, the open subcutaneous wound closed spontaneously, and the patient was discharged on postoperative day 45. He continued oral antibiotics for the next 2 months, and the abscess cavity completely resolved.
Although PSO is rare, it can lead to mediastinitis and should be suspected when anterior chest pain is present. Our case of PSO with acute mediastinitis progressed rapidly over a few days but could be treated with minimally invasive thoracoscopic and subcutaneous drainages, without the need for invasive sternal debridement and drainage.
原发性胸骨骨髓炎（PSO）是一种罕见疾病，其发生时无任何相邻感染病灶，且因PSO导致急性纵隔炎的报道较少。在本报告中，我们描述了一例采用微创方法成功治疗的PSO合并急性纵隔炎病例。
一名71岁男性因前胸疼痛前往当地医生处就诊。他无外伤或胸部手术史。因CT检查发现一些异常，他接受了保守治疗。然而，他的症状加重，13天后再次进行CT检查。CT显示前纵隔左侧及皮下组织有脓肿，同时胸骨有破坏。诊断为急性纵隔炎和纵隔脓肿后，进行了胸腔镜及皮下脓肿引流术。术后血培养检查显示对甲氧西林敏感，我们判断纵隔炎由PSO引起。术后第39天拔除胸腔引流管，开放的皮下伤口自行愈合，患者于术后第45天出院。接下来的2个月他继续口服抗生素，脓肿腔完全消退。
尽管PSO罕见，但它可导致纵隔炎，当出现前胸疼痛时应怀疑该病。我们的PSO合并急性纵隔炎病例在数天内迅速进展，但可通过微创胸腔镜及皮下引流进行治疗，无需进行侵入性胸骨清创引流。
