Advertisement

A Highly Unusual Cause of Right Anterior Proximal Clavicle Pain 5 Years After Uncomplicated Coronary Artery Bypass Surgery

Published:September 15, 2022DOI:https://doi.org/10.1053/j.jvca.2022.09.080
      A 52-YEAR-OLD, 123 kg, 188 cm man, with hypertension, hyperlipidemia, diabetes mellitus, and coronary artery disease, was referred back to the authors’ institution from the emergency department of another Veterans Affairs medical center for evaluation of sharp right chest pain adjacent to his proximal clavicle and superior manubrium of 2 weeks' duration. The patient had undergone uncomplicated coronary artery bypass graft surgery at the authors’ institution 5 years before the current admission. He also described right upper extremity tingling and occasional numbness, but he denied other neurologic complaints. He denied a history of recent trauma and recurrent cardiac symptoms. The physical examination revealed point tenderness at the inferior aspect of the right anterior proximal clavicle. No other painful sites were identified. There were no sensory or motor deficits in the right upper extremity. The median sternotomy incision was well-healed and the sternum was stable without evidence of dehiscence. The remainder of the examination was noncontributory. The laboratory analysis was notable for leukocytosis (white blood cell count = 12.3 K/µL) and mild hyperglycemia (blood glucose concentration = 165 mg/dL), but no other abnormalities were observed. A chest radiograph was obtained (Fig 1). What is the diagnosis?
      Fig 1
      Fig 1Posterior-anterior chest radiograph.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Cardiothoracic and Vascular Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mokhtar AT
        • Baghaffar A
        • Ramer SA
        • et al.
        Migrated fractured sternal wire in proximity to the main pulmonary artery: Case report and review.
        J Card Surg. 2020; 35: 692-695
        • Hazelrigg SR
        • Staller B.
        Migration of sternal wire into ascending aorta.
        Ann Thorac Surg. 1994; 57: 1023-1024
        • Kao C-L
        • Chang J-P.
        Aortic graft pseudoaneurysm secondary to fracture of sternal wires.
        Tex Heart Inst J. 2003; 30: 240-242
        • Radish GA
        • Altinok D
        • Silva J.
        Marked migration of sternotomy wires: A case report.
        J Thorac Imaging. 2004; 19: 117-119
        • Schreffler AJ
        • Rumisek JD.
        Intravascular migration of fractured sternal wire presenting with hemoptysis.
        Ann Thorac Surg. 2001; 71: 1682-1684
        • Levisman J
        • Shemin RJ
        • Robertson JM
        • et al.
        Migrated sternal wire into the right ventricle: Case report in cardiothoracic surgery.
        J Card Surg. 2010; 25: 161-162
        • Abdul Ghani OA
        • Lau J
        • Kemble A
        A runaway sternal wire: A a rare case and outcome of sternal wire intravascular embolization.
        J Cardiol Cases. 2016; 14: 100-102
        • Hartman JB
        • Bhojwani N
        • Markowitz AH
        • et al.
        Unusual cause of intraoperative hemoptysis.
        J Card Surg. 2013; 28: 693-694
        • Hamid Imran U
        • Gillespie S
        • Lynchehaun C
        • et al.
        Traumatic bilateral pneumothoraces due to sternal wire migration.
        Case Rep Med. 2012; 2012438429
        • Daus GP
        • Drez Jr, D
        • Newton Jr, BB
        • et al.
        Migration of a Kirschner wire from the sternum to the right ventricle. A case report.
        Am J Sports Med. 1993; 21: 321-322
        • Al Halees Z
        • Abdoun F
        • Canver CC
        • et al.
        A right ventricle to aorta fistula caused by a fractured sternal wire.
        Asian Cardiovasc Thorac Ann. 2007; 15: 453-454
        • Ethier T
        • Bisleri G
        • Ribeiro IB
        • et al.
        Surgical removal of migrated broken sternal wire using endoscopic assistance.
        Ann Thorac Surg. 2020; 109: e107-e108
        • Abe I
        • Miyoshi M
        • Fukuda T
        • et al.
        Fractured sternal wire with distal migration and penetration of the right ventricle.
        Circ J. 2020; 84: 2032
        • Barakat MJ
        • Morgan JA.
        Haemopericardium causing cardiac tamponade: A late complication of pectus excavatum repair.
        Heart. 2004; 90: e22
        • Cope SA
        • Rodda J.
        Cardiac tamponade presenting to the emergency department after sternal wire disruption.
        Emerg Med J. 2004; 21: 389-390
        • Lee SH
        • Cho BS
        • Kim SJ
        • et al.
        Cardiac tamponade caused by broken sternal wire after pectus excavatum repair: A case report.
        Ann Thorac Cardiovasc Surg. 2013; 19: 52-54
        • Mieno S
        • Ozawa H
        • Katsumata T.
        Ascending aortic injury caused by a fractured sternal wire 28 years after surgical intervention of pectus excavatum.
        J Thorac Cardiovasc Surg. 2010; 140: e18-e20
        • O'Connell BP
        • DeNino WF
        • O'Rourke AK
        An unusual foreign body in the neck: A case of sternal wire migration.
        Clin Med Rev Case Rep. 2015; 2
        • Marshall KD
        • Weese SL.
        Man with chest pain and lump in neck.
        Ann Emerg Med. 2018; 71: 169-188
        • Ziter Jr, FM
        Major thoracic dehiscence: Radiographic considerations.
        Radiology. 1977; 122: 587-590
        • Boiselle PM
        • Mansilla AV
        • Fisher MS
        • et al.
        Wandering wires: Frequency of sternal wire abnormalities in patients with sternal dehiscence.
        AJR Am J Roentgenol. 1999; 173: 777-780