Delayed infected hematoma in retrosternal area following total thyroidectomy: a case report.

Introduction and Importance: Postoperative neck hematoma (PNH), a rare complication following thyroidectomy, occurs in only 1.1-3.15% of cases and can lead to life-threatening outcomes. More rarely, delayed PNHs with atypical clinical manifestations and positions have not yet been reported. Early identification and immediate medical intervention are of utmost importance in such cases. Case Presentation: The authors represented a patient with thyroid cancer adherent to the trachea, who underwent post-thyroidectomy, experienced delayed PNH in the retrosternal region and was infected by respiratory pathogens. Meanwhile, the patient developed recurrent laryngeal nerve (RLN) paralysis after surgery. PNH was not identified in the clinical manifestations; instead, it was detected only through successive cervical ultrasound examinations. Clinical Discussion: Although rare, PNH can lead to serious complications, especially delayed complications or those in atypical positions, without neck swelling. When simultaneously with RLN paralysis, the hematoma may be neglected. Therefore, early diagnosis and treatment are crucial. Conclusion: Clinicians should be vigilant of atypical PNH because neck swelling may be absent. Cervical ultrasonography is essential for diagnosis and can be performed multiple times. Cervical CT scans should be part of the routine procedure, while contrast-enhanced ultrasound can help detect active bleeding. Early postoperative antibiotics are recommended if the tumor is closely attached to the trachea.

[Morphology of sternum for formation of the biological profile of unidentified individual]. / Morfologiya grudiny dlya formirovaniya biologicheskogo profilya neopoznannogo individa.

Identification of a person by general group characteristics does not lose its relevance over a long period. An analysis of publications (2000-2023) devoted to the possibilities of using the sternum to determine gender and age showed a fairly large amount of work on this topic, with very promising results. The trend in the development of this area is the use of modern methods of medical imaging. This becomes the starting point for conducting such studies on the territory of the Russian Federation and developing a methodology that includes the Russian population, taking into account their population characteristics.

A Spatio-Temporal-Dependent Requirement of Sonic Hedgehog in the Early Development of Sclerotome-Derived Vertebrae and Ribs.

Derived from axial structures, Sonic Hedgehog (Shh) is secreted into the paraxial mesoderm, where it plays crucial roles in sclerotome induction and myotome differentiation. Through conditional loss-of-function in quail embryos, we investigate the timing and impact of Shh activity during early formation of sclerotome-derived vertebrae and ribs, and of lateral mesoderm-derived sternum. To this end, Hedgehog interacting protein (Hhip) was electroporated at various times between days 2 and 5. While the vertebral body and rib primordium showed consistent size reduction, rib expansion into the somatopleura remained unaffected, and the sternal bud developed normally. Additionally, we compared these effects with those of locally inhibiting BMP activity. Transfection of Noggin in the lateral mesoderm hindered sternal bud formation. Unlike Hhip, BMP inhibition via Noggin or Smad6 induced myogenic differentiation of the lateral dermomyotome lip, while impeding the growth of the myotome/rib complex into the somatic mesoderm, thus affirming the role of the lateral dermomyotome epithelium in rib guidance. Overall, these findings underscore the continuous requirement for opposing gradients of Shh and BMP activity in the morphogenesis of proximal and distal flank skeletal structures, respectively. Future research should address the implications of these early interactions to the later morphogenesis and function of the musculo-skeletal system and of possible associated malformations.

Sonographic features of sternal pseudotumour in children.

Introduction: Sternal pseudotumour is an important but rare entity thought to be an inflammatory, non-neoplastic lesion that can mimic tumours. The purpose of this paper was to illustrate the imaging features of this lesion to avoid unnecessary investigations. Methods: The clinical notes and imaging features of four patients with a diagnosis of sternal pseudotumour were reviewed over a period from February 2016 to July 2019. Results: All patients were afebrile with no history of trauma. The median age at presentation was 12.5 months. The median length of symptoms prior to presentation was 3.5 days. One patient had a mildly elevated C-reactive protein. Chest radiographs showed a pre-sternal soft-tissue mass, with or without osseous destruction of the subjacent sternum. Ultrasound showed a heterogeneous, hypoechoic pre-sternal soft-tissue mass with variable internal vascularity with extension between sternal ossification centres. CT and MRI showed an enhancing dumbbell-shaped lesion with a pre-sternal and retro-sternal soft-tissue component. The median time to complete resolution was 3 months. One patient had a biopsy that showed chronic inflammation and fibrosis. Discussion: These lesions present in young children typically with a 1- to 2-week history of a focal 2- to 4-cm swelling over the sternum. The aetiology is unknown but may be on the basis of a yet-to-be identified pathogen. Inflammatory markers and cultures are normal or mildly elevated. Important differential considerations include sternal osteomyelitis or neoplastic causes such as Ewing sarcoma, rhabdomyosarcoma, Langerhans cell histiocytosis and infantile fibrosarcoma. Conclusion: Sternal pseudotumor is a rare but important entity to be aware of to avoid unnecessary invasive biopsy or further investigations. Our suggestion is that this is a 'Don't touch' lesion that requires close short-interval follow-up at a surgical outpatient clinic and with ultrasound until resolution.

Clinical Efficacy of Percutaneous Osteoplasty Under Fluoroscopy and Cone-Beam CT Guidance for Painful Sternal Metastases: A Case Series.

Background: Although percutaneous osteoplasty (POP) has been widely accepted and is now being performed for the treatment of painful bone metastases outside the spine. It is emerging as one of the most promising procedures for patients with painful bone metastasis who are unsuitable for surgery or who show resistance to radiotherapy and/or analgesic therapies. However, there are only scarce reports regarding osteoplasty in painful sternal metastases. Subjects and Method: We report four patients with sternal metastases suffered with severe pain of anterior chest wall. The original tumors included lung cancer and thyroid cancer. For the initially pain medication failing, all the four patients received POP procedure under fluoroscopic and cone-beam CT (CBCT) guidance, and obtained satisfying resolution of painful symptoms at 6-month postop follow-up. Conclusion: POP is a safe and effective treatment for pain caused by metastatic bone tumors in the sternum. In practice, however, percutaneous puncture of pathologic sternal fractures can be a challenge because of the long flat contour and the defacement by lytic tumor of bony landmarks. We find that the use of fluoroscopic and CBCT can facilitate POP for flat bone fractures with displacing the trajectory planning, needle advancement, and cement delivery in time.

Chondrosarcoma of the Sternum: Surgical Challenges, Chest Wall Reconstruction, and Postoperative Management.

Although rare, primary chondrosarcoma is the most frequent malignant tumor of the sternum. It commonly manifests as a painful, expanding mass arising from the costochondrosternal junction. Since it is resistant to radiotherapy and chemotherapy, surgical resection with reconstruction is the preferred treatment. A 50-year-old male presented with swelling over the left fourth sternocostal joint, gradually increasing in size. Imaging and clinical assessment suggested an infiltrative neoplasm, and surgical resection was indicated. The patient underwent a partial sternectomy, including a resection of the xiphoid process and costal cartilages two to seven and a partial resection of the manubrium. Postoperative pathohistological analysis specified the change as a low-grade chondrosarcoma in the pT1 stage. Chest wall reconstruction involved three pectus bars fixated around the ribs and the placement of a synthetic polypropylene mesh. The patient required postoperative rehospitalization due to partial skin layer wound dehiscence, serous drainage, and fever. Empirical antibiotic therapy was initiated, and the patient underwent a median superior laparotomy with partial omentoplasty of the sternal region, preserving the mesh and pectus bars. A culture analysis revealed methicillin-resistant Staphylococcus epidermidis, and postoperative antibiotic therapy was adapted to the antibiogram. Subsequently, all parameters of inflammation decreased, and wound healing followed. A one-year follow-up CT scan showed no disease recurrence. This case highlights the intricate surgical management that contributed to the successful treatment of sternal chondrosarcoma. Sternal wound infection, a severe postoperative complication with a high mortality rate, requires prompt identification, precise revision with culture-directed antibiotics, and effort to preserve the prosthetic material.

The utility of sternum in creating a biological profile: A review and future directions.

This review delves into the forensic utility of the sternum in creating a biological profile, focusing on sex, stature, and age estimation. Emphasizing the sternum's significance in challenging scenarios, the study supports the combined length of the manubrium and sternal body as a crucial indicator in sex and stature estimation. However, it highlights the need for caution in applying findings across diverse populations and questions the reliability of Hyrtl's law. Age estimation, primarily based on morphological changes and ossification ages, is explored, with one study showing promise but requiring further validation. While acknowledging the sternum's advantages, the review underscores potential limitations and the absence of specific studies on ancestry estimation, leaving this aspect open for future research. In conclusion, the review provides a comprehensive overview of the sternum's forensic applications, urging continued research to enhance accuracy and applicability.

Occult Breast Cancer Presenting as Sternum Pain.

Bone metastasis has been reported in up to 70% of patients with advanced breast cancer. A total of 55.76% of skeletal metastases in women were derived from breast cancer. However, patients with bone metastasis from an occult primary breast cancer are a rare subset of patients. Here, we present the case of a 38-year-old woman who had sternum pain for 4 months. A whole-body PET-CT scan revealed that the FDG uptake of both the sternum and internal mammary node was significantly increased. The final diagnosis of occult breast cancer was established by immunohistochemical (IHC) staining, which is of great significance for identifying the origin of a metastatic tumor despite no visualized lesions of mammary glands.

The World's First Implantation of a Personalized Microporous Titanium Sternum with Motile Costal Clip Connections: A Case Report.

Extensive chest wall defects occur in 28% of all sternal resection cases and are a major challenge in thoracic surgery. These cases are generally considered "critical defects" requiring primary or secondary reconstruction using various types of flaps, mesh repairs, bone autografts, or endoprosthesis. The past decade witnessed rapid advances in the application of personalized endoprostheses in thoracic surgery. Surgeons began to use carbon or titanium grafts for personalized sternum replacement. The main advantages of these implants are superior cosmetic effect, biocompatibility, and low risk of infection. Herein, we present a case of a 55-year-old patient with an indication for extended sternum resection due to metastatic thyroid cancer. The patient underwent extended sternum resection, followed by the implantation of a personalized microporous titanium sternum equipped with graspers for atraumatic rib fixation.

Sternoclavicular Tuberculosis: An Unusual Presentation.

Extra pulmonary tuberculosis is on the rise worldwide, and younger patients, are females. And people from Asia and Africa are at high risk. Sternoclavicular TB is extremely rare, even in countries that have a high prevalence of TB. It can be in the absence of pulmonary TB. It has a varied clinical presentation. Painless chest wall swelling can be the presenting symptom of sternoclavicular diagnosis. Ultrasonography and high-resolution computed tomography can identify the nature of the lesion and the extent of bone involvement. Aspiration from the swelling or histopathology examination is mandatory for diagnosis. Caseous necrosis is diagnostic of TB. Detection of acid-fast bacilli in smears or tissue or molecular methods is required for definitive diagnosis. A high degree of clinical suspicion is required for early diagnosis. The treatment of thoracic TB is the subject of controversy. Anti-tubercular drugs are the mainstay of treatment. Surgical intervention is basically for flattening cold abscesses and removing infected tissue, including affected bones and cartilage.

Rare case of chondrosarcoma of the manubrium sterni: Management challenges and insights (a surgical case report).

INTRODUCTION AND IMPORTANCE: Chondrosarcoma of the manubrium sterni is an exceedingly rare localization of chondrosarcoma. Its treatment poses a significant therapeutic challenge due to the tumor's proximity to the mediastinal organs and the clavicles. This challenge is magnified when the inner ends need to be resected due to tumor contact with the sternoclavicular joints and, more critically, during the reconstruction of the thoracic wall. CASE PRESENTATION: We present the case of a 71-year-old female with a 45x42x51 mm chondrosarcoma of the manubrium sterni, extending to both sternoclavicular joints. The diagnosis was confirmed cytologically and histologically after an ultrasound-guided biopsy. A surgical strategy involving en bloc resection of the manubrium sterni, the internal ends of both clavicles, and the first two ribs, followed by sternal reconstruction using a synthetic manubrial plate and titanium costal staples without clavicular bridging, was indicated and executed. CLINICAL DISCUSSION: This case outlines the surgical considerations and techniques adopted for this complex procedure, emphasizing the operative planning and interdisciplinary collaboration required for a successful outcome. CONCLUSION: At 18 months post-surgery, the patient demonstrated favorable clinical and radiological progress, indicating a positive response to the treatment strategy employed.

Congenital Absence of Sternum: A Surgical Technique for Successful Outcome.

Congenital absence of sternum is a rare malformation of the anterior chest wall that needs surgical correction to avoid life-threatening complications as a consequence of such defect. It results from either partial or complete failure of fusion of mesenchymal strip during in utero organogenesis. The absence of sternum entails the risk of trauma to the mediastinal structures and other life-threatening complications. This defect is evaluated by a thorough clinical examination and computed tomography imaging of the thoracic cage to plan the surgical procedure. Early repair of the defect when the thoracic cage is still compliant yields the best result.

The Sima de los Huesos thorax and lumbar spine: Selected traits and state-of-the-art.

Information on the evolution of the thorax and lumbar spine in the genus Homo is hampered by a limited fossil record due to the inherent fragility of vertebrae and ribs. Neandertals show significant metric and morphological differences in these two anatomical regions, when compared to Homo sapiens. Thus, the important fossil record from the Middle Pleistocene site of Sima de los Huesos (SH) not only offers important information on the evolution of these anatomical regions within the Neandertal lineage but also provides important clues to understand the evolution of these regions at the genus level. We present the current knowledge of the costal skeleton, and the thoracic and lumbar spine anatomy of the hominins found in Sima de los Huesos compared to that of Neandertals and modern humans. The current SH fossil record comprises 738 vertebral specimens representing a minimum of 70 cervical, 95 thoracic and 47 lumbar vertebrae, 652 rib fragments representing a minimum of 118 ribs, and 26 sternal fragments representing 4 sterna. The SH hominins exhibit a morphological pattern in their thorax and lumbar spine more similar to that of Neandertals than to that of H. sapiens, which is consistent with the phylogenetic position of these hominins. However, there are some differences between the SH hominins and Neandertals in these anatomical regions, primarily in the orientation of the lumbar transverse processes and in the robusticity of the second ribs. The presence of some but not all of the suite of Neandertal-derived features is consistent with the pattern found in the cranium and other postcranial regions of this population.

Sternal cleft: new options for reconstruction.

Sternal cleft (SC) is a rare congenital affection caused by the absence of sternal bar union. Diagnosis is generally made after birth due to paradoxical midline movement, although it can be made prenatally by ultrasonography. A computerized tomography scan (CT scan) after birth is generally used to confirm the diagnosis, assess other intrathoracic conditions, classify the SC, and plan for surgery. SC can be classified as complete or incomplete. A complete SC has a full gap between sternal bars. An incomplete SC is subdivided into superior or inferior, related to the point of bone fusion between the sternal bars. The goal of surgical treatment is to protect mediastinal structures. Many authors advocate the repair in newborn patients, although it can be performed in older patients. The main argument in its favor is the chest's flexibility, with a reduced risk of compression of the mediastinal structures. There are several cases of series and distinct surgical techniques in the literature. Some authors have suggested the use of autologous tissue, prosthetic material such as mesh, or titanium plates and screws. Although difficulties are often encountered in surgical access, they have not been discussed. Therefore, we are promoting modifications to the technique in response to this. The purpose is to show innovations, and how to deal with adversity during the procedure.

Sternal resection and reconstruction: a review.

Sternal resection and reconstruction is a rare but sometimes challenging procedure due to its profound anatomical and functional implications. For these reasons, an adequate preoperative evaluation is crucial in each patient, especially when we are faced with malignant lesions that sometimes require extensive radical resections, thus demanding an integrated reconstructive strategy that allows stabilizing the chest wall, protecting the underlying mediastinum and minimize resulting deformity. The large number of available reconstruction techniques and the lack of quality studies for their analysis mean that sternal reconstruction depends to a great extent on the consensus of experts or, more frequently, on the simple preference of each surgical team. This article aims to provide an overview of sternal resection and reconstruction. Indications for partial versus total or subtotal sternectomy are suggested and their surgical and oncological outcomes are presented. The use of rigid or semi-rigid prostheses is an ongoing debate, although recent functional data advise reserving rigid reconstructions for extensive defects. Sternectomy for primary tumors or local tumor involvement has a good prognosis with an overall survival of 5 and 10 years: 67% and 58%, respectively, provided that a radical resection with free surgical margins is performed. Breast cancer is the most common secondary sternal tumor, and surgery can offer 5-year overall survival ranging from 20% to 50% provided an R0 resection is achieved, although radical surgery does not appear to decrease rates. of recurrence. Metastases of origin other than the breast give the worst results (less than 40% at 36 months and 0% at 5 years) and although the data available on these cases are limited, the radicality of the resection does not seem to modify the survival or recurrence rates, so a conservative approach is probably more appropriate.

Sternal Metastasis of Lung Cancer: A Case Report and a Review of the Literature.

Primary sternal cancer is exceptionally rare. Secondary sternal cancer typically arises when cancer spreads either through the bloodstream from other sites or directly from neighboring lung or breast cancers. Pain is the primary symptom, but these metastases can lead to skeletal-related events such as pathological fractures, hypercalcemia, and spinal cord or nerve compression, necessitating surgical or radiotherapy interventions. These events contribute to increased morbidity and costs for both patients and the healthcare system. We report the case of a 63-year-old female patient who presented with a sternal mass and whose further investigations revealed metastatic lung cancer in the sternum.

Forced Straightening of the Back Does Not Improve Body Shape.

BACKGROUND: Sitting for a long time causes various postural problems, such as slump sitting. It has been reported that employing a corrected sitting position while lifting the sternum is effective in improving this form of posture. We investigated how a corrected sitting posture with the lifting of the sternum is different from a forced position that is applied through the command and passive positions. MATERIALS AND METHODS: The postural angle of 270 subjects aged 19-23 years was measured in the passive, forced, and corrected positions using a Saunders inclinometer and a Formetric 4D system. RESULTS: As a result, the corrected position had a small range (min-max) at all angles, but the forced position and passive position had a large range (min-max). The lumbar lordosis angle in the corrected position showed positive values throughout its range (min-max), while the other groups showed negative values, which indicates the kyphotic position of the lumbar section. In addition, the percentage error in the corrected position was small, but it presented high values in the other groups. When comparing the average angles between the groups, there were substantial changes observed between the corrected position and the other groups. It was found that the corrected position with the sternum lifted, which is applied to improve slump sitting in the clinical environment, exhibited an angle that differed from that of the forced position and the passive position. CONCLUSIONS: Our results suggest that a forced position on the command "scapular retraction" does not meet the clinical assumptions of posture correction, in contrast to the corrected position with the lifting of the sternum for the improvement of slump sitting. The accurate correction of the position of the sternum and sacrum improves the position of the spine in the sagittal plane, enabling physiological values for the kyphosis and lordosis angle parameters to be obtained. This approach combines the ease of execution and precision of the effect. The fact that this method does not require complex tools to accurately correct the body encourages the implementation of this solution in clinical practice.

Resection of Renal Cell and Prostate Carcinoma Sternum Metastases with Long-Term Follow-Up: A Report of 2 Cases.

Introduction: Rarely solitary sternum metastases are addressed by resection. Two additional cases are presented as they are interesting because of their long-term follow-up. Case Presentation: Case 1: A renal cell carcinoma was treated by transabdominal nephrectomy at age 64. Right iliac bone and sternum metastases were diagnosed 7 months later and treated by internal hemipelvectomy followed by sternum metastasectomy 6 weeks after the internal hemipelvectomy. At 12-year follow-up, the patient appears disease free. Case 2: Prostate cancer was treated by prostatectomy at age 67. A subsequent solitary sternum metastasis was resected 10 years later for persistent PSA-activity despite repeated radiotherapy. The patient remains asymptomatic for 3 years now. Conclusion: Resection of sternum metastases may have curative potential and should be considered in tumours known to be rather resistant to chemo- and/or radiotherapy.

Anatomical study and meta-analysis of the episternal ossicles.

Episternal ossicles (EO) are accessory bones located superior and posterior to the manubrium, representing an anatomical variation in the thoracic region. This study aimed to investigate the prevalence and developmental aspects of EO in global populations. The prevalence of EO in pediatric populations was assessed using the "Pediatric-CT-SEG" open-access data set obtained from The Cancer Imaging Archive, revealing a single incidence of EO among 233 subjects, occurring in a 14-year-old patient. A meta-analysis was conducted using data from 16 studies (from 14 publications) through three electronic databases (Google Scholar, PubMed, and Journal Storage) encompassing 7997 subjects. An overall EO prevalence was 2.1% (95% CI 1.1-3.0%, I2 = 93.75%). Subgroup analyses by continent and diagnostic methods were carried out. Asia exhibited the highest prevalence of EO at 3.8% (95% CI 0.3-7.5%, I2 = 96.83%), and X-ray yielded the highest prevalence of 0.7% (95% CI 0.5-8.9%, I2 = 0.00%) compared with other modalities. The small-study effect was indicated by asymmetric funnel plots (Egger's z = 4.78, p < 0.01; Begg's z = 2.30, p = 0.02). Understanding the prevalence and developmental aspects of EO is crucial for clinical practitioners' awareness of this anatomical variation.